URINARY
RETENTION
DUE
TO
HEMATOCOLPOMETRA
Report
of Two
Cases-One
with
Spontaneous
Recovery
By ALLAN BLOXSOM,
M.D.,
AND NORBORNE POWELL,M.D.
Houston,
Texas
H
EMATOCOLPOMETRA
may
be
one
of
the
extrinsic
causes
of
acute
urinary
retention
in the
female.
It can
eventuate
in spontaneous
recovery
due
to rupture
of the hymen with results which are both startling and comforting to the patient.
Occa-sionally there is associated a partial intrinsic narrowing of the urethra.
CASE REPORTS
Case 1. E.F.S. (AE 8989 Jefferson Davis Hospital), a 13-year-old Negro female, reported through the courtesy of Dr. Marvin Rape, was seen in the accident room for treatment. She was in acute distress and gave a history of not urinating for 24 hours. There was considerable pain through-out the abdomen. Family history was essentially normal and she had had no operations. There had been menstrual molimina but no menarche.
Physical examination revealed a distended bladder about half way above the symphysis. A #16 olive tip catheter was inserted easily into the bladder and it was emptied of approximately 500 cc.
of clear, concentrated urine. Urinalysis was normal.
There was a bulging mass in the vaginal orifice which was tender to pressure. Under novocaine anesthesia the intact hymen was incised and 1000 cc. of thick chocolate-colored menstrual fluid was evacuated with immediate relief of the abdominal discomfort. Palpation revealed both tubes and ovaries normal and uterus normal, though displaced upward and posteriorly.
One
week
later the patient returned to the clinic and examination revealed pelvic organs in normal position. The patient at this time stated that she had had no difficulty in voiding and no further discomfort in her abdomen. She had some bloody vaginal discharge for several days after the evacuation of the hematocolpos. She has not returned to the clinic since and it is presumed thatshe
has been permanently relieved of her urinary difficulty.Case 2. C.E.E., a white female, age 12 years 3 months, was seen in the emergency room at St. Joseph’s Hospital, giving a history of swelling in her abdomen for a week and not voiding for 12 hours. The mother stated that she had noticed that the child had been rather full in her abdomen for several months, but she thought the immediate present difficulty dated back about a week. At that time the child had had some difficulty in voiding and complained that she felt that her bowels had to move. This feeling was never entirely relieved. There was no menarche or symptoms sugges-tive of the menarche.
Physical examination showed the girl to be in considerable distress. Perspiration was noticed on her forehead and she held herself doubled up. There was a large mass in the lower abdomen, about seven inches in diameter. This mass was smooth, extended about 5 cm. above the symphysis and was somewhat tender. The vaginal orifice was occluded by a bulging mass.
She was sent to the X-ray room for roentgenograms of the mass in the abdomen. After two films were made (Fig. 1), she was asked to sit up in order to get off the table. As she did so there was a sudden release of about a gallon of a bloody chocolate-colored fluid. An additional plate of the abdomen was made and the mass had completely disappeared.
She was sent home with the advice to report in two days for an urologic examination. Both breasts were developed. The abdomen showed no tenderness and there was no discomfort in either costovertebral angle. On deep pressure over the symphysis there was some discomfort.
There was a reddish-colored bulging mass in the vaginal
orifice
which
was tender
to the touch.
From the Department of Urology, Baylor University College of Medicine.
568
ALLAN
BLOXSOM
AND
NORBORNE
POWELL
On bimanual palpation about one ounce of fluid could be felt in the region of the vagina and by pressure per rectum a thin trickle of menstrual fluid was expelled through a tiny rent in the hymen.
There was a tight urethra, which was dilated to a #22 F.S. before a #20 McCarthy penendoscope was introduced. The bladder was normal. The urethra showed some polypoid granulations in the posterior part, and at six oclock (posteriorly) there was a definite suburehral intrusion into the urethra. It is easy to see how distention of the vagina with the menstrual fluid would have occluded
FIG. 1
completely this narrowed, slightly obstructed bladder neck and urethra. The hymenal rent was easily enlarged by forceps.
Roentgenograms during intravenous pyelography showed the kidneys, ureters, and bladder to be of normal size, outline and position. Both kidneys excreted the dye well. There was a slight dilation of the minor calices of the left kidney.
COMMENT
Acute complete urinary retention due to hematocolpometra as compared to bladder
evi-URINARY
RETENTION
DUE
TO
HEMATOCOLPOMETRA
569
bladder. The retained blood in the vagina associated with the obstruction at the vesical
neck with further angulation as the result of the forward pressure of the
blood-filled
uterus upon the posterior wall of the bladder resulted in the acute urinary retention. The
fourth case was described by Mouradian.3 No mention was made of any intrinsic urethral narrowing. The fifth case reported in the literature was by Tompkins4 in 1939. No
men-tion was made of any intrinsic urethral narrowing. The sixth case reported was by Lacal,5
and the seventh by Flax.6
In both of Lazarus’ cases and in one of the cases reported here there was a slight
obstruction of the urethra made complete by the accumulation of menstrual fluid in the
vagina. Relief through spontaneous rupture of the hymen has occurred only in the
one
case
reported
here.
SUMMARY
Two
additional
cases
of
acute
urinary
retention
due
to hematocolpometra
have
been
added
to the
seven
cases
already
reported.
In three
of the
nine
cases
reported
there
has
been
a partial,
congenital,
intrinsic
obstruc-tion
of
the
urethra
which
together
with
the
extrinsic
hematocolpometra
resulted
in the
complete
bladder
obstruction.
Spontaneous rupture of the overstretched hymen can occur ; and, when it does, it leads
to relief
and
recovery.
REFERENCES
1. Snodgrass, M. R., Acute urinary retention in female; report of case due to hematocolpometra, J.A.M.A. 97:777, 1931.
2. Lazarus, J., Two cases of urinary retention from vaginal occlusion, New York J. Med. 32:330, 1932.
3. Mouradian, A. H., Acute urinary retention due to hematocolpometra, M.
J.
and Rec. 135:369, 1932.4. Tompkins, P., Treatment of imperforate hymen with hematocolpos, J.A.M.A. 113:913, 1939. 5. Lacal, F., Retencion aguda completa de orina por hematocolpos, Rev. san mil, Buenos Aires
40:843, 1941.
6. Flax, H. J., Hematocolpos in young girl causing complete urinary retention, Bol. Asoc. Med. de Puerto Rico 38:453, 1946.
SPANISH ABSTRACT
Retencion
Urinaria
Debida
Al
Hematocolpometra.
Informe
de
dos
Casos-Uno
Con
Restablecimiento
Espontaneo
Sc ha sabido de dos casos de completa retenci#{243}n urinaria aguda debida al hematocoipometra. En un caso hubo alivio espont#{225}neo debido a que ci himen se fractur#{243} cuando Ia paciente se sent#{243}en Ia mesa de ex#{225}men.Han habido siete casos anteriores en Ia literatura adem#{225}s de los dos mencionados aqul, y se cree que tres de los nueve casos han tenido un estrechamiento cong#{233}nito intrinsico de Ia uretra.
