{"paper_id":"21798a3d-b2ff-4fe6-93d7-2dea3bf5c3fd","body_text":"Recurrent Urinary Retention in a Postmenopausal Woman Secondary to Pedunculated Cervical Myoma: A Case Report at Iringa Regional Referral Hospital in Tanzania\nBackground:\nRecurrent urinary retention in postmenopausal women is uncommon and may result from obstructive pelvic masses,\nincluding cervical myomas. Pedunculated cervical myomas are rare and can be misdiagnosed on imaging, leading to\ndelays in definitive treatment.\nCase Presentation:\nA 68-year-old woman (P2 L2) from Iringa, Tanzania, presented with a 10month history of incomplete bladder\nemptying and recurrent urinary retention. Her condition gradually progressed from partial to complete retention, initially\nmanaged with urethral catheterization and metal dilation (urethral bouginage) with partial relief. She had no prior pelvic\nsurgeries, trauma, or neurological deficits, and her medical history was notable only for well-controlled hypertension.\nThe patient had multiple admissions for recurrent urinary retention. In July 2025, she underwent laparotomy for\nsuspected abdominal pathology, and an inflamed appendix was removed, without relief of urinary symptoms. In August\n2025, evaluation revealed a firm, non-tender mass palpable through the posterior fornix on per vaginal examination.\nLaboratory investigations were unremarkable. Ultrasound demonstrated a large adnexal cystic mass, while CT imaging\nsuggested a peritoneal cystic lesion; however, it failed to identify the cervical myoma.\nManagement and Outcome:\nThe patient underwent exploratory laparotomy under general anesthesia. Intraoperatively, a large pedunculated\ncervical myoma measuring 45 × 35 cm was found impacted in the pouch of Douglas, causing bladder neck obstruction.\nTotal abdominal hysterectomy was performed, with careful ligation of the round ligaments, utero-ovarian ligaments,\nuterine vessels, and uterosacral and cardinal ligaments. The myoma weighed 10 kg. Estimated blood loss was 200 mL, and\nhemostasis was achieved. Postoperatively, the patient’s urinary symptoms resolved, and she was able to void normally.\nConclusion:\nPedunculated cervical myomas, though rare, should be considered in postmenopausal women presenting with\nrecurrent urinary retention. Imaging studies may not reliably detect these masses, highlighting the importance of\nthorough pelvic examination and consideration for exploratory surgery. Total abdominal hysterectomy is an effective\ntreatment for symptomatic large cervical myomas causing lower urinary tract obstruction.\nKeywords : Pedunculated Cervical Myoma, Post Menopause, Urinary Retention, Total Abdominal Hysterectomy, Case Report.","source_license":"CC0","license_restricted":false}