Diagnosis and Management of Periurethral Cysts

Abstract

Background/Aims: Periurethral cysts are a rare entity that may be confused with urethral diverticula. The protocol for diagnosis and management of these lesions is still unclear. We present our experience with six patients presenting with periurethral cysts. Methods: From 2001 to 2005 we evaluated six patients with a paraurethral mass. History, physical examination, laboratory and radiographic findings were analyzed to determine factors helpful in mass diagnosis. Cyst excision was performed via trans-vaginal approach in all patients and outcomes of this approach were assessed. Results: Six female patients, average age of 29.7 years, presented with the complaint of a paraurethral mass. Transvaginal sonography was performed in two patients to confirm the presence of a periurethral cyst. Cystourethroscopy in all patients revealed no communication between the cyst and the urethra or presence of other lesions. Pathology revealed a benign cyst in all patients. No cyst recurrence has been seen in any patient. Conclusion: Most periurethral cysts can be diagnosed by physical examination. The diagnosis may be confirmed with transvaginal sonography. Cystourethroscopy should be performed to rule out other pathology, but may be done in the same setting as surgical excision. Complete surgical excision is effective and is associated with minimal risk of recurrence during short-term follow-up.

A diagnostic conundrum: Is it a periurethral diverticulum/cyst or a bulking agent (Bulkamid)?

“…These presenting features are easily mistaken for other lower urinary tract lesions and require a high index of suspicion 14 . In contrast, a periurethral cyst is defined as a sac containing liquid or semisolid material found anywhere along the course of the urethra but which is not consistent with a diverticulum 15 …”

Female paraurethral leiomyoma: treatment and long-term follow-up

“…Urethral leiomyomas can be identified before surgery with a reasonable grade of certainly based on their clinical and imaging features [14,16]. Multiple imaging modalities are available, including transvaginal ultrasonography, pelvic MRI, voiding cystourethrography, and computed tomography (CT) scanning [17]. Ultrasonography and MRI can aid in identifying the exact mass location and possible solid components, tissue infiltration, or tissue planes between the mass and urethral tissue for surgical planning [18].…”

Benign masses of the female periurethral tissues and anterior vaginal wall

“…A Skene's duct cyst presents as a cystic mass at the posterior lateral aspect of the urethral meatus [ 42 ]. Symptoms of the Skene's gland cyst include a local mass of the distal urethra, dyspareunia, dysuria, vaginal discharge-distorted voiding stream, and in one case report, urinary retention [42][43][44][45]. Some lesions are asymptomatic.…”