Urethral Leiomyoma in Pregnancy: A Rare Case of Symptomatic Pelvic Mass With Successful Surgical Management.

Leiomyomas, benign tumors derived from smooth muscle, are typically found in the uterus. Urethral involvement is an exceptionally rare occurrence, particularly in the context of a pre-fashioned thigh flap. Our case, therefore, presents a unique and intriguing instance, with only a few similar cases reported. We present a case of a 27-year-old primigravida at 11 weeks gestation with a protruding anterior vaginal mass, pelvic heaviness, and recurrent urinary complaints. A well-circumscribed vascular mass came out through the vulval orifice on physical examination. Transvaginal ultrasonography and pelvic magnetic resonance imaging revealed a 6×4 cm-sized mass that originated from the anterior vaginal wall, and it did not invade the adjacent structures. The surgical resection through anterior vaginal route with the use of spinal anesthesia. Histopathological examination revealed urethral leiomyoma, and the diagnosis was supported by positive immunoreactivity for the smooth muscle markers. The recovery following surgery was uneventful, and the pregnancy was carried to term with a successful normal delivery, instilling hope and optimism in similar cases. Our case underscores the crucial role of obstetricians and gynecologists in considering urethral leiomyoma in the differential diagnosis of anterior vaginal wall masses, even in pregnancy. This emphasis on early multimodal treatment can significantly impact the outcome; good results can be achieved, and pregnancy outcomes can be improved with curative therapy.