V2-14: Vaginal excision of perivesical mass
VideoIntroductions and Objectives
Patients with perivesical or periurethral mass compressing the bladder neck can present with storage and/or voiding lower urinary tract symptoms (LUTS). We report a case of 49-year-old woman presented with mixed LUTS. Vaginal exam revealed a small firm anterior vaginal wall mass on the right and at the level of the bladder neck. Vaginal exam was otherwise unremarkable. Post void residual volume was 135 ml. Pelvic MRI showed a 3x3 cm mass at the right side of the bladder compressing the bladder neck. MRI suggested the diagnosis of leiomyoma. Transvaginal ultrasound guided biopsy was diagnostic for leiomyoma. In this video, we present our technique of excision of a perivesical mass using the vaginal approach.
With the patient in the lithotomy position, a right paramedian anterior vaginal incision was made. Dissection was carried down to the level of the mass. The mass was completely removed. The bladder defect was closed. Cystoscopy confirmed patency of the ureters and watertight bladder closure. The dead space left after mass removal was closed in multiple layers. Foley catheter was left in place for one week after which cystogram confirmed absence of extravasation and Foley was removed.
Patient had vaginal excision of the perivesical mass. Operative time was 1 hour and 45 minutes. Estimated blood loss was 100 ml. Patient’s voiding and storage symptoms were resolved at 2- month follow up.
Vaginal approach is a viable option for excision of vaginally accessible perivesical masses.