Recurrent Urinary Retention in a Postmenopausal Woman Secondary to Pedunculated Cervical Myoma: A Case Report at Iringa Regional Referral Hospital in Tanzania

Background: Recurrent urinary retention in postmenopausal women is uncommon and may result from obstructive pelvic masses, including cervical myomas. Pedunculated cervical myomas are rare and can be misdiagnosed on imaging, leading to delays in definitive treatment.  Case Presentation: A 68-year-old woman (P2 L2) from Iringa, Tanzania, presented with a 10month history of incomplete bladder emptying and recurrent urinary retention. Her condition gradually progressed from partial to complete retention, initially managed with urethral catheterization and metal dilation (urethral bouginage) with partial relief. She had no prior pelvic surgeries, trauma, or neurological deficits, and her medical history was notable only for well-controlled hypertension. The patient had multiple admissions for recurrent urinary retention. In July 2025, she underwent laparotomy for suspected abdominal pathology, and an inflamed appendix was removed, without relief of urinary symptoms. In August 2025, evaluation revealed a firm, non-tender mass palpable through the posterior fornix on per vaginal examination. Laboratory investigations were unremarkable. Ultrasound demonstrated a large adnexal cystic mass, while CT imaging suggested a peritoneal cystic lesion; however, it failed to identify the cervical myoma.  Management and Outcome: The patient underwent exploratory laparotomy under general anesthesia. Intraoperatively, a large pedunculated cervical myoma measuring 45 × 35 cm was found impacted in the pouch of Douglas, causing bladder neck obstruction. Total abdominal hysterectomy was performed, with careful ligation of the round ligaments, utero-ovarian ligaments, uterine vessels, and uterosacral and cardinal ligaments. The myoma weighed 10 kg. Estimated blood loss was 200 mL, and hemostasis was achieved. Postoperatively, the patient’s urinary symptoms resolved, and she was able to void normally.  Conclusion: Pedunculated cervical myomas, though rare, should be considered in postmenopausal women presenting with recurrent urinary retention. Imaging studies may not reliably detect these masses, highlighting the importance of thorough pelvic examination and consideration for exploratory surgery. Total abdominal hysterectomy is an effective treatment for symptomatic large cervical myomas causing lower urinary tract obstruction.