Leiomyomas are benign tumors of smooth muscle origin and are rarely found in the lower urinary tract. Removal is often technically challenging due to a location deep in the pelvis with difficult exposition.

Data from seven patients with leiomyoma of the lower urinary tract and treated via transurethral surgery in Notes-technique by using the minimal suturing device instruments. Between May 2016 and December 2023, was analyzed retrospectively. Analysis included number, size and localization of the leiomyomas, symptoms, voiding function and complications. Preoperatively the diagnosis was confirmed by ultrasound guided biopsy.
Setting: A rigid cystoscope with 30 degree optics is inserted into the bladder with CO(2) insufflation. After inspecting and finding the lyomyoa is manipulated and cut out with an endoscopic hooklet. First the monocryl 3-0 fibre is put into the needle holder. To fit into the needle is bended. The needle is put loose next to the cystoscope put into the bladder and after touching the wall the fibre is fixed at the end of the needle holder with a clamp. Now by a rotation the whole is at both sides stiched. With a grasp -put through the working channel- the needle is grasped and by loosing the clamp everything can be pulled out. By tying an extracorporal knot and putting an knot pusher over the fibre, the knot is fixed. This procedure is repeated till the whole is closed. The fibres are cutted.

Patients presented with signs and symptoms including a palpable external genital mass, dysuria, urge urinary incontinence or dyspareunia. Usually physical examination revealed a non-tender mass, 1.2-2.8cm in diameter, with a smooth surface located above the urethra or bladderneck. The masses were sharply dissected and enucleated via transurethral bladderoscopy. No postoperative complications were found. Two weeks after the procedure, all patients had a normal voiding function. Terminal histopathological examination showed leiomyomas with fascicles with spindle-shaped cells without mitosis.

To reduce morbidity and prolonged recovery of Leiomyomas of the lower urinary tract - TUS-NOTES technique is efficacious and the preferred method of intervention. The mean operative time was 55 min (35min-110min), whereas the blood loss was less 10ml. The patients were discharged 3 days after surgery, and the catheter were removed 10 days after surgery.

In management of Leiomyomas of the lower urinary tract, a transvesical approach via bladderoscopy is a safe and feasible alternative to laparoscopic or transvaginal treatment. To reduce morbidity and prolonged recovery of excision of the Leiomyomas of the lower urinary tract - TUS-NOTES technique is efficacious and the preferred method of intervention. The prognosis is excellent since it has no risk of malignant transformation.

Continence 12S (2024) 101578
DOI: 10.1016/j.cont.2024.101578