Incidental Urinary Bladder Leiomyoma: A Successful Long Term Conservative Treatment Based on Pre-operatory Magnetic Resonance Imaging Findings

Background: Leiomyomas are benign mesenchymal neoplasms which rarely occur in the urinary bladder, accounting for just 0.43% of all bladder tumours. Due to the paucity of data, very little is known about diagnosis, treatment and follow-up. Thus, despite their nonmalignant nature, they may be considered a true therapeutic challenge. Objective: Conservative management is paramount when assessing and managing benign neoplasms. It is the responsibility of the surgeon to tailor the most appropriate surgery for each patient, finding the best balance between oncologic and functional outcomes and future quality of life. Case report: We present a case report of a patient who was incidentally diagnosed with a large, asymptomatic intramural leiomyoma of the urinary bladder. Following abdominal imaging, biopsy specimens were obtained through cystoscopy, and a transurethral resection of the bladder (TURB) was eventually performed. Imaging findings including Ultrasonography (US), triple-phase Computed Tomography Urography (CTU) and Magnetic Resonance Urography (MRU) are reported, and the most representative images are shown. The patient has been successfully managed with staged TURB and then close outpatient follow-up, and she is currently recurrence-free 8 years after the last endoscopic treatment. Conclusion: Despite the benign nature of leiomyomas, the surgical options for these tumours range from TURB to radical cystectomy. Here, we underline how a conservative approach may be successful regardless of the size and site of the lesion, thus preserving the bladder and the patient's quality of life without affecting the oncologic outcomes.