CASE REPORT Leiomyoma in the Retzius space: a rare cause for voiding difficulties Christl Reisenauer & Rosita Walz-Mattmueller & Erich-Franz Solomayer & Katja Siegmann & Diethelm Wallwiener & Manfred Wehrmann Received: 12 December 2006 / Accepted: 20 February 2007 / Published online: 13 March 2007 # International Urogynecology Journal 2007 Abstract A 54-year-old woman with voiding difficulties was referred to our department. She complained about a slow urine stream, hesitancy, straining when voiding and the feeling of incomplete emptying. The gynaecological examination revealed a 4×3 cm pelvic tumour. The tumour was well circumscribed in the retropubic space between the symphysis and the bladder neck sonographically and by magnetic resonance imaging and was closed off from neighbouring structures. After removal of the tumour, the voiding problems were reversed, and the patient has remained asymptomatic. The histological examination showed a leiomyoma with high vascularisation. This case report showed that retropubic tumours can obstruct the urethra and cause voiding dysfunctions. Consequently, this needs to be considered in the differential diagnosis. Keywords Leiomyoma . Retropubic space . Voiding difficulties Introduction In the differential diagnosis of voiding dysfunctions, tumours or tumour-like lesions located in the Retzius space must be taken into consideration, although they occur only rarely and are not usually described in the textbooks. Research in literature (PubMed search using the follow- ing terms: “retropubic space, Retzius space”) showed that only four cases of true tumours in the Retzius space were reported. Not all of them were primarily associated with voiding problems. A cystic lymphangioma in a 9-year-old boy manifesting itself as an acute abdomen was described [1]. A case of aggressive angiomyxoma in the Retzius space was reported by Payne et al. [2]. Stutterecker et al. [3] described two cases of leiomyoma in the Retzius space, one without symptoms and one with increasing voiding diffi- culties. Tumour-like lesions in the Retzius space were haematomas during anticoagulant therapy, detected during a prospective study [4]. Another haematoma of the Retzius space was reported after spontaneous and uncomplicated delivery associated with urinary retention and pain in the hypogastric region radiating to the left hip and leg [5]. A spontaneous abscess in the Retzius space with extraperi- toneal presacral dissemination was described by Borten and Friedman [6]. We will present and discuss an exemplary case of voiding dysfunction caused by a leiomyoma located in the Retzius space in front of the bladder neck. The patient was 54 years old and had an abdominal hysterectomy due to leiomyomas. Case report A 54-year-old multiparous woman was referred with voiding difficulties, a poor stream and hesitancy, the need Int Urogynecol J (2007) 18:1229–1231 DOI 10.1007/s00192-007-0337-5 C. Reisenauer (*) : E.-F. Solomayer : D. Wallwiener Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany e-mail: christl.reisenauer@med.uni-tuebingen.de R. Walz-Mattmueller : M. Wehrmann Institute of Pathology, University of Tuebingen, Liebermeisterstrasse 8, 72076 Tuebingen, Germany K. Siegmann Department of Diagnostic Radiology, University of Tuebingen, Hoppe Seyler Strasse 3, 72076 Tuebingen, Germany