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 34-year-old multiparous woman was admitted at 7.2 weeks of gestation with acute urinary retention and a mass in the upper vaginal wall. She had adenomyosis (uterus size, 10.4 cm × 11.6 cm), and a 2-week history of increased urinary frequency and a sensation of incomplete bladder emptying. In the emergency room, 850 mL of urine was drained by urinary catheterization. Transvaginal (TV) ultrasound and MRI showed no specific findings except a retroverted gravid uterus with adenomyosis, and an elongated and anteriorly displaced cervix behind the pubic symphysis (; TV ultrasound, ; MRI). Nonetheless, uterine incarceration was clinically suspected. The change in uterine polarity was noted after manual reduction (), and a pessary was inserted to prevent recurrence (74 mm; Smiths Medical, Minneapolis, MN, USA). The pessary was removed at 15 weeks, and the patient delivered a healthy male baby weighing 3,100 g at 38 weeks. Ultrasound examination performed at 6 weeks after delivery showed a retroverted uterus with a slightly thickened wall, although it was thinner than expected ().