PELVIC LIPOMATOSIS

Abstract

Although usually in the domain of the urologist, pelvic lipomatosis sometimes may present itself to the general surgeon. Often called perivesical lipomatosis, this process of unknown etiology was defined as a nonmalignant overgrowth of fatty tissue limited primarily to the peritectal and perivesical spaces in the pelvis. Typically it occurs in middle-aged, monobese, men presenting with dysuria and sometimes suprapubic fullness. High position of the prostate may be noted on rectal examination. Urinary tract roentgenograms show a high, gourd-shaped bladder with the surrounding radiolucency of fatty tissues. Elongation of the urethra usually makes cystoscopy difficult. Sigmoidoscopy and Ba enema may reveal extrinsic pressure on the rectum. Pelvic venography rarely shows external venous compression. Arteriography does not suggest neoplastic vessels. Fat metabolism studies are of little value. The absence of adequate cleavage planes renders direct surgical management difficult. The frequently progressive lower ureteral obstruction eventually may require urinary diversion. Four biopsy-proved cases from the Eastern Virginia Medical School Hospitals are reported and 57 previous cases from the literature are reviewed.