Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 1 , Pages 69-71, March 2005

Three-Dimensional Sonography in the Exploration of Voiding Dysfunction in Retroverted Impacted Adenomyosis: A Case Report

  • Pu-Tsui Wang
    • ,
  • Jenn-Ming Yang

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr. Jenn-Ming Yang, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan

Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan

Received 11 March 2004; received in revised form 23 March 2004; accepted 23 March 2004.

Article Outline

Summary 

Objective

Retroverted impacted adenomyosis may cause progressive lower urinary bladder compression, resulting in bladder outflow obstruction and lower urinary tract symptoms. We report a case of a huge impacted adenomyosis in which the pathogenesis of bladder outflow obstruction was explored using three-dimensional sonography and was clearly shown to be different from that of pelvic-organ prolapse. The pathogenesis of urinary retention is described and discussed.

Case Report

A 43-year-old patient was admitted for acute urinary retention and a huge impacted retroverted uterus with adenomyosis. Sonographic study revealed that the lower urinary bladder was compressed by the cervix, which was upwardly and forwardly displaced. Three-dimensional sonography more clearly identified the bladder neck and adjacent tissue.

Conclusion

Sonography is helpful in exploring the anatomic nature of bladder outflow obstruction resulting from retroverted impacted adenomyosis. In this case, the urethra was neither distorted nor compressed, quite different from cases with pelvic organ prolapse. These two types of bladder outflow obstruction are not distinguishable using traditional urodynamic study. Three-dimensional sonography is more helpful in identification of the compressed reshaped lower urinary bladder and its adjacent anatomic structures, even without urine in the low bladder cavity as contrast.

Key Words:  adenomyosis , outflow obstruction , three-dimensional sonography

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References 

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PII: S1028-4559(09)60111-X

doi:10.1016/S1028-4559(09)60111-X

Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 1 , Pages 69-71, March 2005

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