Summary: A 50-year-old African-American man presents with nocturia, postvoid dribbling and sensations of incomplete
emptying. Cystogram followed by computed tomography (CT) intravenous pyelogram (IVP) were obtained.
Single fluorscopic image demonstrates a superiorly displaced, pear-shaped bladder. CT
IVP reveals marked proliferation of pelvic adipose tissue compressing and
elevating the bladder as well as obstruction of the bilateral ureters resulting
in severe bilateral hydronephrosis. Mass effect on the adjacent bowel with
elongation and narrowing of the rectum and sigmoid colon is also present. A
post-CT radiograph redemonstrates these findings.
Pelvic lipomatosis is a rare disease of unknown etiology characterized by exuberant overgrowth of
pelvic adipose tissue. African-American males are most commonly affected, typically
presenting in middle age. The condition is rare in females. Obesity has been
thought to contribute to pathogenesis, however this is controversial as weight
loss is infrequently curative. Endocrine dysfunction and chronic lower urinary-tract infection have also been suggested
as risk factors.
Most cases are discovered incidentally. When symptomatic, patients
typically present with complaints relating to compression of the urinary system, lower intestinal tract,
or vascular system. Renal failure suggests advanced disease and warrants prompt
Cystogram and pyelogram classically demonstrate upward mass effect with stretching of the bladder and posterior
urethra resulting in the pear-shaped appearance of the bladder. Cross-sectional
imaging reveals proliferation of pelvic adipose tissue with scattered
inflammatory and fibrotic components. Urinary tract obstruction with
hydronephrosis is common.
Patients with deteriorating renal function or severe symptoms often require urinary diversion. Others may be
treated conservatively. Cystitis glandularis, cystica, or follicularis complicates
the majority of cases, but malignant degeneration has been infrequently reported.
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