Obstructive uropathy with acute pyelonephritis induced by a voluminous postmenopausal uterine leiomyoma.

Uterine myomata at different locations and of differing sizes usually produce different symptoms, including menorrhagia, tenesmus or frequent urination and, occasionally, pelvic pain. Although logically possible, significant obstructive uropathy is rarely associated with the compression of a uterine leiomyoma. We report a case of a large uterine leiomyoma presenting with bilateral hydroureter, hydronephrosis, acute pyelonephritis, and impaired renal function. A female aged 55 years, gravida 2, para 2, was sent to the emergency room because of spiking fever and chills with ineffective antibiotic treatment for 1 week. She was healthy before these symptoms arose and was menopausal for 4 years without any hormonal supplement or vaginal bleeding. An obvious pelvic mass in the lower abdomen was noted, with tenderness and mild muscle guarding, but without obvious urinary frequency, obstructive bowel symptoms or pelvic discomfort. Physical examination revealed marked pain over the bilateral costovertebral angle of her back. The hemogram showed leukocytosis with a left shift (white blood cell count, 12,200/μL; segmented neutrophils, 84%), a biochemistry test revealed impaired renal function (serum creatinine, 2.0 mg/dL), and urine analysis found pyuria, hematuria and bacteriuria. Renal ultrasound revealed bilateral hydroureters, with mild right hydronephrosis and moderate left hydronephrosis. No renal stones or renal cysts were noted. The large pelvic mass was shown in transabdominal ultrasonography as a heteroechogenic uterine mass measuring 18.8×11.5 cm, compatible with a degenerated uterine leiomyoma. Computed tomography observed the large pelvic mass obliterating the entire pelvic cavity, compressing the bilateral pelvic side wall (Figure 1A), obliterating the whole inlet of the anterior pelvic brim (Figure 1B), and having associated bilateral hydroureters and hydronephrosis. There were no identifiable lymphadenopathies, ascites or pleural OBSTRUCTIVE UROPATHY WITH ACUTE PYELONEPHRITIS INDUCED BY A VOLUMINOUS POSTMENOPAUSAL UTERINE LEIOMYOMA