Pelvic lipomatosis (PL) involves nonmalignant excess fat growth in perirectal and perivesical areas, gaining recognition over three decades. This review addresses its clinicopathological aspects amid controversies, emphasizing the need for a comprehensive examination of current literature. This report outlines a 42-year-old man's diagnostic journey for persistent urological symptoms, ultimately identified as PL. PL, if untreated, adversely impacts the urinary system, affecting kidney function and causing systemic complications. Management involves accurate diagnosis through radiological methods and surgical intervention, aiming to alleviate symptoms and enhance affected individuals' quality of life.

Pelvic lipomatosis (PL) is a rare condition that is characterized by excessive growth of fat in the pelvic cavity. Studies have yet to systematically review surgical treatments for PL.

To provide a reference for selecting reasonable surgical treatments for PL patients according to previous literature on the surgical treatment of PL.

We conducted this systematic review in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) of Individual Participant Data guidelines. Literature on PL published from 1968 to 2022 was retrieved from the PubMed and EMBASE databases. Data were collected and analyzed independently by two independent investigators.

A total of 42 studies, involving 231 patients with PL, were included in the analysis. The surgical treatments included transurethral resection (TUR) (48.5%), ureteral stent placement (11.7%), percutaneous nephrostomy (1.3%), ureterocutaneostomy (1.3%), ureteral reimplantation (10.4%), ileal conduit (13%), and allograft kidney transplantation (0.4%). After excluding patients with unclear prognoses, 42.9% of patients showed improvement in lower urinary tract symptoms (LUTS) after TUR. Ureteral stent placement provided relief of hydronephrosis in 62.5% of PL patients. Percutaneous nephrostomy resulted in stable renal function in 33.3% of PL patients, while ureterocutaneostomy led to remission of postoperative hydronephrosis in 33.3% of PL patients. After ureteral reimplantation, 70.8% of patients experienced relief of hydronephrosis or had stable renal function. Ileal conduit led to remission of hydronephrosis, alleviation of symptoms, or maintenance of stable renal function in 83.3% of PL patients. One patient with PL had stable renal function after allograft renal transplantation.

The surgical treatments for PL include TUR, ureteral stent placement, urinary diversion, and allograft renal transplantation. However, the choice of surgical method should be determined after comprehensive consideration of the patient's condition.

To predict the diagnosis of pelvic lipomatosis (PL) by assessing CT imaging parameters.

Fifty clinically proven PL patients and 50 controls were included. Two radiologists recorded the types of bladder shapes and measured the following CT imaging parameters: (1) pelvic fat volume (PFV); (2) a set of morphological indices of bladder and rectosigmoid, including the ratio of craniocaudal to anterior-posterior length of bladder (CC/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), right and left angles between bladder and seminal vesicle (RABS and LABS), distance from verumontanum to anterior wall of rectum (DVR) and rectosigmoid morphological index (RMI). Secondary complications were also noted.

The results were evaluated by an unpaired t test, ROC analysis and logistic regression. All CT imaging parameters except RMI (p = 1.000) indicated a statistical difference between PL and controls (p < 0.01). The AUCs of these parameters were between 0.724 (for rLPU) and 0.993 (for AAP). The sensitivity and specificity were 94% and 98% for AAP and 92% and 94% for the combined model, respectively. 23 patients were pathologically diagnosed with cystitis glandular. The incidence of hydronephrosis in the PL group was higher than that in the control group (p < 0.01).

CT imaging parameters can predict the diagnosis of PL. The combined model of objective parameters including PFV, rLPU and DVR showed the best diagnostic performance for PL.

The aim of this study was to report the experience and long-term efficacy of a novel surgical treatment for pelvic lipomatosis (PL) using a combination of pelvic fat mass extirpation and ureteral reimplantation.Data of 8 patients with PL who underwent pelvic fat mass extirpation and ureteral reimplantation at our hospital from September 2010 to March 2018 were retrospectively reviewed. Demographics, serum creatinine level, radiographic changes, perioperative complications, and patient-reported outcomes were evaluated.Surgeries were performed successfully without severe perioperative complications in all 8 patients. Median operating time was 150 minutes with a median estimated blood loss of 75 mL. Patients were discharged after a median of 8.5 postoperative days. Imaging studies at the first follow-up revealed varying extents of alleviation of hydronephrosis and 3 patients' urinary symptoms were gradually relieved after surgery. During a median follow-up of 48.5 months (range, 10-100 months), all patients exhibited excellent surgical outcomes without evidence of disease progression, except 1 patient who underwent radical cystectomy with Bricker ileal conduit surgery due to hydronephrosis recurrence in the 49th postoperative month.Based on these cases, pelvic fat mass extirpation and ureteral reimplantation is a safe and effective surgical treatment for PL.

To explore urodynamic characteristics and their clinical value in pelvic lipomatosis (PL) patients.

We reviewed the clinical information of 84 PL patients. A voiding pressure-flow study was used to classify patients into nonoutlet obstruction (NOO), latter-half-section obstruction (LHSO), or whole-section bladder outlet obstruction (BOO) groups. Urinary morphologic features were measured by imaging examination and cystoscopy.

A unique LHSO that presented as sudden increasing detrusor pressure (Pdet) and decreasing flow rate in the latter half of voiding was observed for 52.4% (44 of 84) patients. Overall, 27.4% (23 of 84 patients) were diagnosed with BOO with whole-section increasing Pdet and decreasing flow rate. According to the morphologic feature analyses, the NOO patients had the largest angle of anteroposterior vesical walls (P < 0.001) and the least severe thickened bladder trigone (P = 0.015). The external compression at the bladder neck and thickened bladder trigone caused a prolonged and strictured bladder outlet tract (see the Supplementary video). There were 0, 5, and 4 urinary diversions performed in the NOO, LHSO, and BOO groups at diagnosis (P = 0.055). No patients in the NOO group, seven in the LHSO group, and two patients in the BOO group had disease progression at follow-up. Two LHSO patients and one BOO patients without hydronephrosis at diagnosis developed to hydronephrosis during follow-up.

Morphologic alterations of the urinary system of PL patients lead to unique LHSO or BOO on UDS. The presences of LHSO and BOO are associated with disease severity and progression.

To study whether the individual radiological findings can help predict diagnosis of pelvic lipomatosis (PL) or, specifically appreciate its progression.

Data from 32 clinically proven cases of PL and 25 controls were collected. Two reviewers were recruited for a blinded evaluation, image features were recorded in terms of: (1) bladder shape; (2) bladder-rectosigmoid morphological indexes including ratio of superior-inferior to anterior-posterior length of bladder (SI/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), angle between bladder and seminal vesicle (ABS) and rectosigmoid morphological index (RMI); (3) secondary complications. Results were evaluated by an unpaired t test and ROC analysis.

The sensitivity and specificity were 40.6% and 100% for pear and banana-shaped bladder, 62.5% and 100% for SI/AP, 40.6% and 100% for AAP, 62.5% and 100% for ABS, 78.1% and 72% for rLPU, 59.4% and 96% for RMI, respectively. These radiological findings partially correlated with the severity of disease weighted by hydronephrosis and treatment grade. Image analysis demonstrated high prevalence of glandular cystitis (100%) and hydronephrosis (73.4%).

We conclude that PL is a progressive disease involving multiple pelvic organs with high prevalence of intractable cystitis and hydronephrosis. The imaging characteristics can help predict diagnosis and, specifically appreciate progression.

We report a rare case of giant mesenteric lipoma presenting with colicky abdominal pain. A 29-yr-old woman underwent laparoscopic resection for a giant mesenteric lipoma causing compression of the ileal loop. The resected ileal segment was encased by a giant fatty tissue, and normal mucosal fold patterns of the resected ileum were effaced by the mass. Microscopically, the mass was characterized by homogenous mature adipose tissue without cellular atypia, which was compatible with the diagnosis of a mesenteric lipoma. Despite the benign nature of this tumor, total excision with or without the affected intestinal loop should be considered if intestinal symptoms such as abdominal pain are present.

Lipomas are the most commonly occurring mesenchymal tumors. We report a technique used to manage a patient with a large dumbbell-shaped pelvic lipoma passing through the obturator foramen. Using the combined expertise of an orthopedic and pelvic surgeon, successful and safe removal of this benign dumbbell-shaped pelvic lipoma was achieved.

A diffuse fatty infiltration of all the intrapelvic organs (bladder, rectum, sigmoid, colon) was present in a 67-year old-man. This led to the typical topographical and functional changes in the organs affected. Treatment has been very controversial. Surgical measures such as exeresis of the fat tissue with or without the intrapelvic organs affected by the abnormal fat deposition with subsequent drainage (colostomy/ileum conduit) were carried out. Conservative treatment with or without temporary cortisone administration was recommended. Pelvic lipomatosis is diagnosed radiologically. If there is no unequivocal restriction in the function of the affected organs, treatment should remain conservative.

We have a case of pelvic lipomatosis in a patient suffering from right flank pain and urinary syndrome. Before completing the diagnostic test, abdominal traumatism forced to perform a laparotomy of emergency. We found a great deal of retropubic mass with bladder rupture and thickened walls caused by perivesical fat. The anatomopathological diagnosis was pelvis lipomatosis. This is an unusual case of bladder rupture after slight traumatism.

Shoulder girdle lipomatosis is a distinct type of lipomatosis which has unique clinical and radiographic features. The MR findings reflect the pathologic findings and, in our opinion, allow the differentiation of shoulder girdle lipomatosis from other lipomatous masses on the basis of imaging findings alone.

We report an unusual case of long-standing bladder outlet obstruction due to pelvic lipoma in a 31-year-old white man. The mass was evaluated by plain film, computerized tomography and magnetic resonance imaging. The differential diagnosis of fat-containing extraperitoneal pelvic masses is discussed.

From 1950 through 1985, 18 patients 26 to 65 years old (mean age 44.5 years) presented with pelvic lipomatosis. Followup ranged from 6 months to 17 years, with a mean of 7.5 years. Of these 18 patients 16 (89 per cent) are alive, 1 (6 per cent) died of uremia and 1 (6 per cent) was lost to followup after 6 months. During this period 7 patients (39 per cent) required operative procedures for urinary obstruction. Although pelvic lipomatosis is a benign proliferation of fat in the true pelvis that is known to lead to urinary tract, fecal and even vena caval obstruction, it also may remain dormant and cause no significant symptoms for many years.

We report a case of pelvic lipomatosis with ureteral obstruction and vesicoureteral reflux. In addition to computerized tomography, nuclear magnetic resonance imaging provided definite and graphic proof of the diagnosis. Operative treatment consisted of ureteroileocystostomy.

Pelvic lipomatosis may increase significantly the difficulty and morbidity of many urologic procedures. Radical prostatectomy in this setting has not been described previously. Such a case is presented and the reported surgical experience in pelvic lipomatosis is reviewed. Considerations in the management of prostatic cancer in patients with this condition are discussed.

Pelvic lipomatosis is a rare condition characterized by excessive accumulation of fat in the pelvis. The symptoms and the course of the disease are related to compression of the lower urinary tract and rectum. The clinical findings and radiological characteristics are described.

Pelvic lipomatosis is uncommon in female subjects. The symptoms and signs are vague in all patients but radiologic studies, especially pelvic computerized tomography, should provide data for the diagnosis and obviate operative intervention. All patients should have careful followup to rule out obstructive uropathy.

Retroperitoneal lipomatosis is a condition in which excessive fat deposits in the retroperitoneum can exert a mass effect, with displacement of normal structures. In the case presented, it displaced lymph nodes and simulated adenopathy in nonopacified nodes. The specific diagnosis of retroperitoneal lipomatosis as the cause of the mass effect can be made by computerized tomography.

A rare case of rectosigmoid compression by an enormous obscure pelvic mass after cystectomy is reported. Pelvic collections in the form of abscess, hematoma, lymphocele, and urinoma are not uncommon in the early postoperative period following pelvic surgery. However, delayed appearance of a benign pelvic mass as a late complication of surgery is very rare. Localized pelvic masses discovered years after cystectomy for bladder tumor may lead to an erroneous clinical impression of local recurrence of the primary neoplasm. Differential diagnosis of common pelvic masses, diagnostic studies, and treatment are discussed.

Hypertrophied iliopsoas musculature should be considered seriously in the evaluation of young muscular male patients presenting with gourd-shaped bladder deformities. The recognition of this nonpathologic gourd deformity during excretory urography and subsequent confirmation by computerized tomography allow an accurate efficient diagnosis, sparing the patient a needless, more extensive investigation.

The authors describe the diagnostic ultrasound findings of pelvic lipomatosis in a patient presenting with lower extremity thrombophlebitis. In this condition, ultrasound shows the full urinary bladder to assume a tubular or "cigar" shape and to "float" in the pelvic fat with failure to distend normally to the pelvic side walls. Confirmatory computed tomography discloses normal muscular and osseous anatomy but an increase in radiolucent fat surrounding the pelvic viscera. Clinical and radiographic findings are reviewed, and a differential diagnosis is presented.

Twelve patients with pelvic "lipolymph nodes" were seen at the Mayo Clinic during a period of 26 years. Most of the patients were perimenopausal or postmenopausal, and all but one were obese. The average size of the nodes was 6.6 cm, with the range being 2 to 14 cm. The most frequently involved nodes were the external iliac and obturator groups. Excretory urography and pelvic ultrasound scan (high-resolution scanner) were helpful in determining the extraperitoneal location and the solid nature of the tumors. Lymphangiography performed in one case was helpful in confirming the nodal origin of the pelvic tumor. Exploratory laparotomy was required to determine the exact nature of the lesion in all patients. The treatment consisted of simple removal of the involved nodes. No recurrences have been observed.

Computed tomography (CT) and ultrasound are emerging as useful diagnostic adjuvants in the confirmation of pelvic lipomatosis. A case of pelvic lipomatosis studied by CT and sonography is presented. These two techniques offer greater precision in the demonstration of fatty tissue density within the true pelvis. The findings appear characteristic and unique. CT and ultrasound confirmation of pelvic lipomatosis provide added confidence in an accurate clinical diagnosis and may obviate the need for diagnostic surgical exploration.

Two cases of retroperitoneal lipomatosis with an unusual distribution are reported. In the first case the fat was confined to the perirectal soft tissues and the sigmoid mesentery, whereas in the second case it was peripancreatic and extended into the small bowel mesentery. The lipomatous nature of these retroperitoneal masses was suggested by the lucency of the fat on the plain abdominal roentgenograms. These cases were studied prior to the availability of computed tomography, so that the diagnoses were confirmed by surgical exploration, which may have been avoided by this currently available noninvasive technique.

Pelvic lipomatosis is a disease characterized by abnormal deposition of mature adipose tissue within the confines of the pelvis surrounding the bladder, prostate, and rectosigmoid. The presenting symptoms are vague and nonspecific, and it has typical radiologic features. Computed tomography is extremely useful in the differential diagnosis because of its ability to differentiate fatty infiltration from other conditions which can cause elevation and compression of the urinary bladder and sigmoid colon. Computed tomographic confirmation of the presence of fat surrounding the bladder and rectum eliminates the need for surgical biopsy, unless indicated for other reasons. The course of this disease is usually benign and indolent, however a close follow-up is mandatory to rule out those cases in which ureteral obstruction may develop requiring surgical relief of the obstruction. When cystitis glandularis is found in association with pelvic lipomatosis, periodic cystoscopic examinations are recommended because of the potential risk of malignant transformation.

Pelvic lipomatosis is a rare, relatively self-limiting disease characterized by the overgrowth of unencapsulated lipomatous tissue within the pelvis. The diagnosis is suggested, but not substantiated, by the striking roentgenographic changes noted on barium enema and intravenous pyelogram. Previously, pelvic laparotomy with tissue diagnosis was essential for documenting the disease. We report three cases in which computerized tomography was utilized as a safe, noninvasive and accurate method of diagnosis. The role played by partial venous obstruction is discussed in addition to rectal bleeding as a mode of presentation.

Followup of 5 cases presented in 1971 and report of 8 additional cases confirm the initial conclusions that pelvic lipomatosis is a benign but potentially progressive process leading to ureteral obstruction. Young black subjects are affected most commonly. More than 40 per cent of the patients have required permanent urinary diversion.

Pelvic lipomatosis has a classic roentgen triad which includes (1) pelvic radiolucency, (2) elevation of an intact rectosigmoid, and (3) elevation of the urinary bladder. This triad, in the absence of other abnormal clinical and roentgen findings, is pathognomonic of pelvic lipomatosis, and surgical biopsy is not necessary to confirm the diagnosis.

Inverted teardrop-shaped bladder deformity ofetn is caused by pelvic lipomatosis or perivesical accumulation of extravasated blood or urine, or both. A foreign body (toothpick) lodged in the bladder and resulting in urinary infection and perivesical inflammation also was found to be capable of causing this unusual bladder deformity. The bladder contour returned to normal after removal of the foreign body and treatment of infection.

Three cases of pelvic lipomatosis are presented. Excretory urogram revealed characteristic elevation and elongation of urinary bladder base and relative hyperlucency of pelvic cavity. Associated varying degrees of hydronephrosis and hydroureters are seen secondary to distal ureteral obstruction. Barium enema showed elongation and elevation of rectosigmoid colon.

Pelvic lipomatosis is a disease of dense infiltration of benign fatty tissue within the confines of the deep bony pelvis. A case is reported of an obese, hypertensive, thirty-nine-year-old black man with the typical clinical and radiographic features of pelvic lipomatosis. Prolonged fasting produced an extensive weight loss and profound resolution of his presenting symptoms, signs, and radiologic abnormalities. Subsequent regain of weight resulted in the reappearance of the disorder, confirming that pelvic lipomatosis may be a disease of accelerated and excessive fat deposition which can be reversed by dietary restriction. The literature pertaining to pelvic lipomatosis is reviewed in detail.