Diagnosis and management of female paraurethral cysts: A tertiary hospital experience

Abstract

Objective: To report a case series of female paraurethral cysts (FPCs) at a tertiary hospital. Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed. Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m2 (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups' operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma. Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment.