Introduction:
The urethral opening, also known as the external urethral meatus, is a crucial anatomical structure that serves as the endpoint of the urinary system in both males and females. Situated at the distal end of the urethra, it is responsible for the passage of urine from the bladder to the outside of the body. The urethral opening plays a vital role in urinary continence, sexual function, and reproductive health. In females, there are small, pea-sized glands located on either side of the urethral opening and are responsible for secreting fluid that helps with lubrication during sexual arousal. These glands are called paraurethral glands, Skene’s glands, Skene’s duct, or periurethral glands.
What Is a Paraurethral Cyst?
When the paraurethral ducts of the paraurethral glands become blocked or obstructed, the secretions accumulate and form a cystic structure called the paraurethral cysts or commonly known as the Skene’s gland cyst. Paraurethral cysts can vary in size. Paraurethral cysts are typically filled with fluid. The fluid inside the cyst can vary in consistency, ranging from clear fluid to thicker fluid or even pus in cases of infection.
What Are the Types of Paraurethral Cysts?
Paraurethral cysts can be further categorized into acquired and congenital types based on their underlying causes:
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Acquired Paraurethral Cyst - These cysts develop later in life and are typically caused by factors such as inflammation, infection, trauma, or blockage of the ducts of the paraurethral glands. Inflammatory conditions, such as urethritis or urinary tract infections, can lead to the formation of acquired paraurethral cysts. Trauma to the area, such as childbirth or pelvic surgery, may also contribute to their development.
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Congenital Paraurethral Cysts - These cysts are present at birth and result from developmental abnormalities or malformations of the paraurethral glands or paraurethral ducts. Congenital paraurethral cysts are relatively rare and may be associated with other congenital conditions affecting the genitourinary system.
What Are the Symptoms of Paraurethral Cysts?
Paraurethral cysts are discovered incidentally during routine pelvic examinations or imaging studies, as they are usually asymptomatic. However, some individuals may present symptoms that can vary depending on the size, location, and individual characteristics of the cyst. Both acquired, and congenital paraurethral cysts cause similar symptoms in the affected females. Some common symptoms associated with paraurethral cysts include:
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Pain or Discomfort - The presence of a cyst near the urethral opening can cause pain or a sensation of discomfort in the surrounding area. This pain may worsen during activities such as urination, sexual intercourse, or physical exertion.
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Swelling - Paraurethral cysts can lead to localized swelling or a palpable lump near the urethral opening. The size of the cyst can vary, ranging from small and barely noticeable to larger, more prominent swellings.
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Urinary Symptoms - In some cases, paraurethral cysts can cause urinary symptoms such as increased frequency, urgency, or difficulty with urination. This can occur if the cyst puts pressure on the urethra or interferes with the normal flow of urine.
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Infection or Abscess Formation - If a paraurethral cyst becomes infected, one may experience symptoms such as increased pain, redness, warmth, and the presence of pus or discharge.
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Sexual Discomfort - Paraurethral cysts may cause discomfort or pain during sexual intercourse due to the pressure or irritation the paraurethral cyst exerts on surrounding tissues.
How Is Paraurethral Cyst Diagnosed?
The diagnosis of paraurethral cysts typically involves some common methods. Diagnostic measures for paraurethral cysts include:
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Medical History - The healthcare provider will discuss your symptoms, including any pain, discomfort, or urinary issues you may be experiencing. They will also inquire about any relevant medical conditions or previous surgeries.
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Physical Examination - The healthcare provider will perform a pelvic examination to assess the area around the urethral opening. They may feel for any palpable masses, swelling, or tenderness. This examination helps to localize the cyst and evaluate its size and characteristics.
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Imaging Tests - Imaging tests may be used to visualize and confirm the presence of the paraurethral cyst. Ultrasound is commonly employed as it can provide detailed images of the cyst and its surrounding structures. In some cases, other imaging modalities, such as magnetic resonance imaging (MRI) scans, or computed tomography (CT) scans may be utilized for a more comprehensive evaluation.
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Cyst Aspiration - In certain cases, if the diagnosis is not definitive or if there is a need to relieve symptoms or obtain fluid for analysis, the doctor may perform cyst aspiration. This involves withdrawal (using a syringe with a needle) of fluid from the cyst for further examination.
How to Treat Paraurethral Cyst?
The treatment of paraurethral cysts, or Skene's gland cysts, depends on various factors, such as the size of the cyst, the severity of symptoms, and the presence of complications. Here are some common treatment options:
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Observation - Small, asymptomatic cysts, especially congenital paraurethral cysts, may not require immediate medical treatment and can be monitored over time to assess any changes or progression. No specific treatment is required if the cyst is not causing significant discomfort or affecting urinary function or sexual activity.
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Antibiotics - If the cyst becomes infected or an abscess forms, the doctor may prescribe antibiotics to treat the infection and reduce inflammation. Once the infection subsides, the cyst may be drained and excised.
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Cyst Drainage - In cases where the cyst is large, causing significant discomfort, or not resolving with conservative measures, the doctor may recommend cyst drainage. This procedure involves aspirating (using a needle and syringe) the fluid from the cyst. Cyst drainage can provide temporary relief of symptoms but may not prevent cyst recurrence.
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Marsupialization - Marsupialization involves creating a small opening in the cyst wall and suturing it into the surrounding healthy tissue. This forms a "pouch" or "marsupial" that allows for ongoing drainage of the cyst's contents. The cyst is not entirely removed but rather converted into an open cavity that gradually heals from the inside out.
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Surgical Excision - Surgical removal of the paraurethral cyst is often the definitive treatment option. It is typically recommended for large cysts, recurrent cysts, symptomatic cysts, or cysts associated with complications. The surgery involves the complete removal of the cyst and is performed under local anesthesia. Minimally invasive techniques, such as endoscopic or laparoscopic approaches, may be utilized for smaller cysts.
Conclusion:
Paraurethral cysts are rare and usually do not cause any severe symptoms or progress into complications. Paraurethral cysts cannot be completely prevented, as their occurrence is often related to anatomical factors or underlying conditions. However, maintaining good hygiene, practicing safe sexual practices, and avoiding irritants may help prevent the development of acquired paraurethral cysts. Paraurethral cysts are harmless, and appropriate treatment measures can always heal the cyst and prevent reoccurrence.
