Uterine Fibroid Embolization for Patients with Acute Urinary Retention Ziv J. Haskal, MD, and Hector Armijo-Medina, MD Acute urinary retention due to uterine fibroids is rare. In reported cases, hysterectomy and myomectomy have been the recommended therapies. Herein, the authors describe two patients with acute obstructive urinary retention who experienced immediate improvement and the ability to spontaneously void after uterine fibroid embolization. The rapidity of response and the nonsurgical nature of this therapy suggest that it may be used as the first-line therapy for this rare event. J Vasc Interv Radiol 2008; 19:1503–1505 THE urinary manifestations of uterine fibroids are diverse, including daily urinary frequency, nocturia, stress uri- nary incontinence, urgency, and ure- teral obstruction and hydronephrosis. The high efficacy and durability of uterine fibroid embolization (UFE) for the control of these symptoms, as well as menorrhagia, have been well char- acterized in numerous studies (1,2). In contrast to these symptoms, acute uri- nary retention due to fibroids is an unusual phenomenon, and has been reported in case reports; its causes in- clude pressure upon the lower bladder and cervix resulting in internal ure- thral orifice compression (3–10). The use of UFE in this setting has, to our knowledge, been described in one pre- vious article (11). Herein, we report the rapid improvement of two patients with uterine fibroids and acute uri- nary retention who required serial bladder catheterizations until treated with UFE. CASE REPORTS Case 1 Institutional review board approval was not required for the preparation of this report. The first patient was a 48-year-old gravida 2, para 1 woman with a 6-month history of an increasing sense of bloating and urinary frequency. In the month preceding the initial consul- tation, she developed multiple epi- sodes of acute urinary retention that necessitated bladder catheterization at her local emergency department. More than 1 L of retained urine was emptied at several visits. Her menses lasted 5 days, of which two were heavy. At transabdominal examination, the uterus was palpable below the umbilicus but was not tender. Pre-UFE magnetic resonance (MR) imaging revealed a 9  12  10-cm uterus with multiple enhancing fi- broids, some of which demonstrated partial central necrosis. The largest fi- broid was in the lower body of the uterus, measuring 7.4  7.1  6.3 in maximum diameters (Fig 1a). UFE was performed in a conventional fash- ion by using 500 –700-m Embosphere particles (Biosphere Medical, Rock- land, Massachusetts). At the routine 1-month follow-up, she reported that immediate post-UFE resolution of her urinary retention had occurred. Spe- cifically, she had no subsequent need for bladder catheterization. At 3- and 8-month follow-up, all bulk symp- toms had resolved and her menses had become much lighter, mimick- ing, by her description, those of more than a decade earlier. The final MR imaging examination performed 8 months after UFE revealed devascu- larization, shrinkage, and infarction of all visible fibroids, with otherwise normal uterine perfusion (Fig 1b). The largest fibroid had shrunk to 5.0  5.5  5.4 cm. The overall uterus size had shrunk to 7.8  7.3  8.5 cm. Clinical improvement was main- tained at 1-year follow-up. Case 2 A 49-year-old gravida 2, para 2 woman with a 2-year history of wors- ening pelvic fullness presented with a 2-month history of new and increas- ingly frequent acute urinary retention requiring intermittent bladder cathe- terization. At one emergency depart- ment visit, 1,900 mL of urine was emp- tied from her bladder. She had begun performing self-catheterization more than once a week. Her menses were relatively light. At physical examina- tion, her uterus was not tender, and no more than approximately 14 week in size. Pre-embolization MR imaging re- vealed a dominant enhancing intra- mural ventral fibroid that measured From the Division of Vascular and Interventional Radiology, New York Presbyterian Hospital/Co- lumbia University, 177 Fort Washington Ave, MHB 4-100, New York, NY 10032. Received March 3, 2008; final revision received June 12, 2008; accepted June 17, 2008. Address correspondence to Z.J.H.; E-mail: ziv1@mac.com Neither of the authors has identified a conflict of interest. © SIR, 2008 DOI: 10.1016/j.jvir.2008.06.014 Brief Reports 1503