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

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. 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. 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.