Conservative treatment and follow-up of vaginal Gartner’s duct cysts: a case series

Abstract

BackgroundIn women, during embryologic development, the paired Müllerian (paramesonephric) ducts fuse distally and develop into the uterus, cervix, and upper vagina. If the Wolffian ducts persist in vestigial form, they can lead to Gartner’s cysts, mainly located in the right wall of the vagina. This is one of the few studies of Gartner’s cysts with a series of consecutive cases over a long period of time who were exclusively subject to clinical observation. Although Gartner’s cysts are found in approximately 0.1 to 0.2 % of women, controversy exists regarding the course of action to be taken.Case presentationWe describe the cases of four women who were 38-years old, 53-years old, 37-years old, and 49-years old at their first appointment and who were of mixed ethnicity, mixed ethnicity, black, and mixed ethnicity respectively. The follow-up of these patients ranged from 2 to 17 years. In these four cases the location of the cysts was the right wall of the vagina. Transvaginal ultrasound was the test of choice for diagnostic confirmation. In the cases presented in this study, the women were asymptomatic and chose to be observed clinically.ConclusionsThis is the first study reporting long-term clinical observation of these lesions. This study shows that conservative treatment can be a safe option for asymptomatic patients with vaginal Gartner’s duct cysts.

Laparoscopic Excision of a Large Gartner’s Duct Cyst

“…The surgical management of a GDC is controversial [3,4]. Vaginal excision has mostly been performed for enormous GDCs [5][6][7].…”

Gartner-Gang-Zyste – eine altersunabhängige Differenzialdiagnose

“…Während der embryonalen Entwicklung ist der Urogenitaltrakt beider Geschlechter zunächst indifferent angelegt. Beim weiblichen Geschlecht entsteht ab der 8. embryonalen Woche aus den paarigen Müller-Gängen (Ductus paramesonephricus) der Uterus, die Zervix und das obere Drittel der Vagina [5,6] Die paarigen Wolff-Gänge (Ductus mesonephricus) bilden sich beim weiblichen Embryo unter fehlendem Einfluss von Androgenen jedoch zurück. Allerdings können aus Relikten des zurückgebliebenen Wolff-Ganges Gartner-Gang-Zysten entstehen [7].…”

“…Die Therapieoptionen sollten sich nach der Beschwerdesymptomatik und Schwere der assoziierten Fehlbildungen orientieren. So wurden, neben konservativen Therapieansätzen bei asymptomatischen Zysten [6], operative Therapieansätze wie Marsupialisation [17] oder Exzision der kompletten Zyste [18], aber auch Ureterektomie bei ektopem Ureterverlauf im Rahmen einer GGZ [1,2] beschrieben. Im Falle einer Doppelniere mit ektop mündendem Harnleiter in der GGZ stellt die Ureteroureterostomie heute eine elegante und gering invasive Alternative zu der früher routinemäßig durchgeführten oberen Heminephrektomie dar [19].…”

Surgical excision of vaginal cysts presenting as pelvic organ prolapse: a case series

“…Surgical excision of the vaginal cyst via vaginal approach is the common management approach, with low recurrence rates [ 7 ]. Drainage is no longer advised due to infection and recurrence risks [ 8 ]. Pathologic confirmation is recommendable to exclude malignancy as they have been reported cases of malignant transformation [ 9 ].…”