Presentation Authors: Eabhann O'Connor*, Huriye Kocadag, Mahreen Pakzad, Rizwan Hamid, Jeremy Ockrim, Tamsin Greenwell, London, United Kingdom
Introduction: Paraurethral cysts may be classified as acquired or congenital, although a clear distinction is often difficult. These cysts may be asymptomatic or present with a palpable vaginal lump, lower urinary tract symptoms (LUTS), dyspareunia or discharge. These rare clinical entities pose a diagnostic challenge and may be mistaken for urethral diverticulum on both clinical examination and with imaging modalities such as magnetic resonance imaging (MRI). The aim of our study was to report the largest series in the literature of complete surgical excision of paraurethral cysts in adult women.
Methods: We retrospectively reviewed a prospectively collected database of 16 consecutive women of median age 35[range 17-54] having surgical excision of paraurethral cysts between October 2011 and April 2017 for presenting symptoms, surgical management and outcomes.
Results: The majority of patients (n=15 (93.8%)) presented with a palpable lump in their vagina. Other complaints included; dyspareunia, discharge and voiding difficulty. Many (n=10 (62.5%)) were referred with a clinical and MRI diagnosis of urethral diverticulum. All patients had video urodynamics and magnetic resonance imaging (MRI) prior to clinic review and peri-operative urethrocystoscopy. 8 (50%) had urodynamic evidence of BOO consequent to their cyst, whilst 3 (18.8%) had evidence of IDO (2 in association with BOO). All the cysts were solitary and measured from 1.1 to 4.5cm in maximum dimensions. 10 (62.5%) of patients underwent simple excision alone, 5 (31.3% ) had cysts that were densely adherent to the underlying distal urethra which was opened during the procedure and required a formal urethral repair with interposition of paraurethral tissue whilst 1 (6.3%) had a large paraurethral cyst densely adherent to the mid and distal urethra which were opened during the procedure and then closed with a formal modified Martius labial fat pad interposition. The median follow-up period was 6 months (2.5-35). No complications were demonstrated, there were no episodes of recurrence and presenting symptoms have resolved in 15 (93.8%).
Conclusions: This is the largest series in the literature describing complete excision of all paraurethral cysts, as opposed to marsupilisation or aspiration alone. Paraurethral cysts may be mistaken both clinically and on MRI for urethral diverticulum. They cause similar symptoms and are associated with urodynamic abnormalities in > 50%. Complete excision resolves symptoms in 93.8% but may required urethral repair and tissue interposition in 37.6%.