Management of Paraurethral Cysts in Adult Women: Emphasis on Physical Examination (A Short Series)

Abstract

Introduction: Paraurethral cysts in adult women are rare. These masses present with non-specific symptoms, making them indistinguishable clinically. The assessment of urethral anatomy is largely based on imaging studies. This study aims to present clinical experience in managing paraurethral cysts. Methods: We present a retrospective chart review of a series of four patients diagnosed with paraurethral cysts that presented to our practice between December 2015 and April 2017, as well as a review of the literature describing these lesions. Paraurethral swellings were initially diagnosed on vaginal examination and further investigated by MRI. The reported cases included patients that underwent surgical excision and those that declined surgery. Results: Our studied cohort included both nulliparous and multiparous patients. The chief presenting complaints were pelvic area pain and tender anterior vaginal swelling. Most patients reported a history of previous intermittent swelling and its resolution. In patients that underwent surgical intervention, all responded well to excision of the cyst with no recurrence. Discussion: Acquired paraurethral cysts are often attributed to prior vaginal delivery or surgical trauma. However, we report a nulliparous patient with no prior vaginal procedure. Physical examination of symptomatic patients was essential in diagnosis and management. Conservative treatment in the patients declining surgery was unsuccessful and the cyst persisted. Conclusions: A review of patients’ history and vaginal examination was sufficient in detecting paraurethral cysts. In cases where a cyst was not detectable and the patient reported recurrent swelling, re-examination, when the patient became symptomatic, was successful in diagnosing the swelling. However, MRI investigation was necessary to review the extent of the lesions prior to complete surgical excision. Excision was effective in all the patients, with no recurrence.