A 28-year-old woman experienced urinary retention occurring at midnight at 12 weeks of her first pregnancy (). She was presented to the Emergency Department for urethral catheterization, which drained 900 ml of clear urine. On vaginal examination, the cervix was drawn up into the anterior fornix behind the symphysis pubis. Transabdominal and vaginal sonography revealed a retroverted uterus with a gestational sac and fetus located in the pelvic cavity (Figs. and ). There were no clinical findings indicating having urinary tract infection or bladder stone, and she had no history of excessive fluid intake (alcohol), constipation or medication.\nThe following prophylactic measures were suggested to the patient: limiting fluid intake before sleep and changing from supine to the prone position for a while before getting up to go to the toilet. Until 14 weeks’ gestation, however, urinary retention requiring urethral catheterization recurred three times. Each catheterization yielded around 600-1000 ml urine. At 15 weeks’ gestation, the gravid uterus was examined and no retroversion was found anymore (). She had no more recurrence of urinary retention during the rest of this pregnancy.\nThree years later, the patient consulted our hospital again due to urinary retention at 11 weeks of her second pregnancy. Urethral catheterization, which drained 600 ml of clear urine, was performed with prompt effect. At this time, transvaginal sonography revealed a retroverted uterus again. She had no recurrence of urinary retention during the rest of the pregnancy.
A 31-year-old primigravida had been admitted to another hospital for 3 days because of acute urinary retention, which was conservatively managed; the management strategy included pain control. She was referred to us at 6 weeks of gestation, with a 12.6 cm × 9.4 cm-sized myoma in the posterior uterine wall. She also complained of urinary retention and dysuria, along with severe back pain. Pelvic examination revealed fullness in the posterior fornix and anterior displacement of the cervix. On bimanual examination, the retroverted uterine fundus was palpable as a large mass in the cul-de-sac. Ultrasound findings showed the uterus entrapped in the pelvis in the hollow of the sacrum along with a posterior myoma (). An indwelling urinary catheter was inserted and 750 mL of urine was drained, with the catheter kept in place.\nManual reduction was attempted by applying steady pressure with two fingers in the posterior vaginal fornix and by pushing the uterus in a cephalad direction without anesthesia while the patient was in the dorsal lithotomy and knee-chest position; however, it failed. Subsequently, gentle bimanual reduction through the rectum and vagina was attempted by applying continuous pressure under ultrasonographic guidance. Subsequently, slight pain reduction was achieved. In order to prevent re-incarceration of the uterus, pessary insertion was attempted; however, it failed owing to the narrow space. Instead, a large gauze was packed in the vagina, the Foley catheter was left in place, and the patient was kept on bed rest for 1 day. Final ultrasound showed a uterine myoma that was positioned slightly upward after reduction (). On the next day, the gauze and Foley catheter were removed. The patient still complained of intermittent back pain but was able to void the bladder, and was discharged. Although the uterine incarceration improved slightly, the patient subsequently had a spontaneous abortion after 1 week, and a myomectomy was conducted for her subsequent pregnancy.