Fibroid uterus causing retention of urine in a nullipara

Aerial view

Rt lateral view

Left lateral view

End-on view

                                                 A 30yr old nulliparous women presented with pain lower abdomen and inability to pass urine for > than 18hrs. She was treated elsewhere with diuretic and analgesia. Later she was catheterised and 1.5 litres of urine was obtained. On ultrasound scan she was found to have an anterior wall fibroid of size 6cm. She was offered a myomectomy, but insisted on a hyterectomy as she had taken an oath of celibacy and was dedicated to God and despite warnings of future problems of early onset menopause and its attendent risk of osteoporosis and heart disease, she was adamant about hysterectomy. The same was performed.

              Although common in men with prostatic disease, urinary retention is an uncommon condition in young women. Etiologies include anti-cholinergic use, detrusor muscle hypotony, infection, pregnancy, prolonged catheter use, myasthenia gravis and other neurologic diseases. Extrinsic causes include a retroverted uterus in pregnancy, large ovarian masses, hematocolpos, uterine prolapse and uterine fibroids. As urinary retention is an uncommon condition in young women, many physicians may have a difficult time making a timely diagnosis. As evidenced by the delay in diagnosis in our patients, Urologists may look for non-gynecologic causes of retention more commonly, and delay pelvic examinations. As pelvic organ etiologies are common causes of retention in women, this delay can lead to unnecessary invasive tests and patient suffering.

Although previously thought uncommon, patients frequently presented with urgency, frequency and intermittent retention prior to complete inability to void. Patients may present with urinary urgency and frequency, recurrent UTI, intermittent difficulty in voiding and defecating and complete and sudden urinary obstruction. Fibroids were commonly found projecting off the posterior uterus, and were often difficult to elevate from the cul-de-sac at the time of surgery because of pelvc impaction.

               Multiple theories have been proposed to explain the mechanism of urinary retention. One common theory describes the incarceration of posterior fibroids into the cul-de-sac causing compression of the urethra against the pubic bone. A large fibroid may weigh down the uterus, causing acute retroversion and compression of the cervix against the proximal urethra (1). This may cause anterior deflection of the cervix and subsequent urethral compression (2). As the fibroid enlarges and becomes incarcerated in the pelvis, the bladder can be stretched across the uterus also affecting function. Other causes of urgency and frequency include urethra elongation causing intermittent voiding dysfunction.
Treatment of urinary retention caused by fibroids includes placement of a pessary to elevate the bladder neck, gonadotropin-releasing hormone receptor agonists to decrease the size of the uterus, uterine artery embolization (UAE), myomectomy and hysterectomy. Although recommended as a treatment for retention and fibroids,  patient can have recurrence of her symptoms after UAE.


              Uterine fibroids that result in compression of the proximal urethra, elongation of the urethra and bladder, can cause voiding dysfunction and urinary retention in young women. These and other pelvic aetiologies should be considered in young women presenting with voiding dysfunction and urinary retention

Related citations

• Uterine fibroid embolization for patients with acute urinary retention. [J Vasc Interv Radiol. 2008]
• Acute urinary retention caused by a uterine leiomyoma: a case report. [J Reprod Med. 2004]
• Review Acute complications of fibroids. [Best Pract Res Clin Obstet Gyn...]
• Objective cure of urinary retention following laparoscopic hysterectomy for a large uterine fibroid. [Int Urogynecol J. 2010]
• Review Acute urine retention in early pregnancy resulting from fibroid incarceration: proposition for management. [Fertil Steril. 2008]