CLINICAL NOTE

 

Female paraurethral cysts. A report of four cases

 

V. Menéndez-López*, E. de Nova-Sánchez**, C. Carro-Rubias**, L. de Paz-Cruz**, F. García-López**

 

*Servicio y Cátedra de Urología. Hospital del Mar. UAB. Barcelona. **Servicio de Urología. Hospital General Universitario de Elche. Alicante (Spain)

 

Actas Urol Esp 2006; 30 (1): 83-84

 

ABSTRACT

FEMALE PARAURETHRAL CYSTS. A REPORT OF FOUR CASES.

Paraurethral cysts are infrequent. We report four cases diagnosed and treated in our hospital during the last 10 years.

Keywords: Paraurethral cyst. Diagnosis. Treatment. Prognosis.

 

Paraurethral cysts are infrequent, and are derived from remnant embryonic tissue or develop as a result of chronic paraurethral gland obstruction. The diagnosis is based on the clinical findings, and radiological studies are advised to demonstrate the absence of communication with the urethra, or the association of other pathologies.

 

CLINICAL CASES

Between 1994 and 2004, four women were seen in Elche University General Hospital (Spain)(mean age: 34 years; range: 21-53 years) due to paraurethral cysts – three in the Service of Urology and one in Gynecology. All patients consulted due to the presence of a tumor lesion adjacent to the urethral meatus. The lesion was between 2 and 3 cm in diameter, and had evolved over the previous 3 to 12 months (one of the cysts of a patient is shown in Figure 1). Only one of the four patients was nulliparous. In no case were there antecedents of urinary infection or micturition alterations of any kind. The tumors were elastic, and no fluid was seen to emerge from the urethra upon applying pressure to the lesions. Urine culture, ultrasound and urethroscopy were carried out in all cases, with normal results.

 

FIGURE 1. Paraurethral cysts adjacent to the urethra.

 

The treatments were as follows: puncture drainage in three cases, which proved ineffective in two patients because the cyst reappeared a few months later; exeresis in one case; and marsupialization in one patient. In all cases the drained fluid was viscous, milky and between yellow and brown in color. Drained fluid culture proved negative.

The cyst wall consisted of transitional epithelium in two cases, and squamous epithelium in another. In one patient, subjected to simple puncture, no histological report was forthcoming.

 

DISCUSSION

Paraurethral cysts are infrequent. They may be congenital or acquired, and the clinical manifestations may be variable – including pain, dysuria, dyspareunia, vaginal secretion or micturition alterations. However, they are most often asymptomatic1. There appears to be no predominance in any particular age group2, and the condition has even been diagnosed in newborn infants3.

The paraurethral glands and their ducts, which open into the urethra, are considered to be rudimentary homologues of the prostate gland. Skene’s glands are a type of paraurethral gland that secrete mucoid material during sexual intercourse to lubricate the urethra during coitus.

These structures, along with the urethra, derive from the urogenital sinus. Migration of the urothelial tissue towards an adjacent zone may be the cause of these cysts, though they may also appear as a result of inflammation and obstruction of the glands4.

The differential diagnosis must be established with prolapsed ectopic ureterocele, Gartner duct cysts. Müllerian remnant cysts, vaginal wall inclusion cysts, urethral or vaginal neoplastic lesions, urethral prolapse and urethral diverticuli.

Urine sediment, abdominal ultrasound and cystourethroscopy appear to be the only techniques required for correct diagnosis2, though some authors recommend cystourethrography5.

Since simple cyst puncture is generally unable to resolve the condition, definitive treatment in the form of marsupialization2 or cyst resection is advised5, with similar results in either case.

 

REFERENCES

1. Stovall TG, Muram D, Long DM. Paraurethral cyst as an unusual cause of acute urinary retention. A case report. J Reprod Med 1989;34(6):423-425.

2. Sharifi-Aghdas F, Ghaderian N. Female paraurethral cysts: experience of 25 cases. BJU Int 2004;93(3):353-356.

3. Blaivas JG, Pais VM, Retik AB. Paraurethral cysts in female neonate. Urology 1976;7(5):504-507.

4. Kimbrough HM Jr, Vaughan ED Jr. Skene’s duct cyst in a newborn: case report and review of the literature. J Urol 1977;117(3):387-388.

5. Deppisch LM. Cysts of the vagina: Classification and clinical correlations. Obstet Gynecol 1975;45(6):632-637.

 

Dr. V. Menéndez-López

Servicio y Cátedra de Urología

Hospital del Mar

Passeig Marítim, 25-29

08003 - Barcelona

E-mail:violetamenendez@wanadoo.es

(Article received on March 8, 2005)