Introduction
The Mullerian or paramesonephric ducts form female genital organs, whereas the mesonephric duct creates male genital organs. A mesonephric cyst, also known as a Gartner's duct cyst, can occasionally develop in females from the mesonephric or Wolffian duct remains. They are typically asymptomatic and around 2 cm, but can get larger. A pelvic examination is used to make the diagnosis. The cyst is surgically removed as a kind of treatment. In urogynecology, this is a rare situation since the symptoms are similar to those of pelvic organ prolapse, but the approach to therapy is quite different.
The Wolffian duct creates the male genital tract. They regress in females. On rare occasions, they might persist, and the caudal section can develop into the vaginal inclusion cyst known as the Gartner duct cyst. They are frequently asymptomatic and discovered by chance during the pelvic exam. Epidermal inclusion cysts, Bartholin duct cysts, and Muellerian cysts are a few more typical vaginal cysts. The Gartner duct cyst commonly coexists with other congenital abnormalities of the kidney.
What Is Gartner Duct Cyst?
When the mesonephric duct, also called the Wolffian duct, fails to retreat, vaginal cysts called Gartner duct cysts (GDCs) may form along certain portions of the duct. The Gartner duct is what's left of the mesonephric duct. GDCs are often seen on the lateral and anterior portions of the vaginal wall, with the posterolateral wall being a rare exception.
In around 25 percent of all adult women with a vagina, the remaining Gartner ducts are found, but only one percent of these women will develop Gartner duct cysts. GDCs are congenital (existing from birth). However, they are typically not recognized until adolescence and, occasionally, late middle age (i.e., 45 - 65).
Can A Cyst In The Gartner Duct Be Cancerous?
Gartner duct cysts are typically benign; however, there have been cases of malignant or cancerous changes.
Why Do Gartner Duct Cysts Develop?
GDCs form from leftover mesonephric ducts (also known as Wolffian ducts) that cannot effectively regress throughout the development of the reproductive and urinary systems. In order to produce the testicles, epididymis, and prostate in embryos with XY chromosomes, the mesonephric duct, is an embryonic structure that is present in all embryos but is only sustained by elevated testosterone. Occasionally, GDCs may subsequently appear in embryos with XX chromosomes that still have portions of the duct.
The Wolffian ducts (mesonephric) and the Müllerian ducts are the two sets of ducts from which the internal urogenital tract is generated (paramesonephric). Both sexes possess these ducts. The paired Müllerian (paramesonephric) ducts in female embryos unite distally during the eighth week of embryologic development to form the uterus, cervix, and upper vagina. The Wolffian ducts also slow down. The ducts may develop Gartner's cysts if they remain dormant. These cysts are most frequently seen in the right anterolateral wall of the vagina and the lateral walls of the uterus. Inadequate Wolffian duct development can also lead to urogenital anomalies, such as modifications to the metanephric urinary system.
What Are the Indications of a Gartner Duct Cyst Based on Signs and Symptoms?
Small and asymptomatic, Gartner duct cysts are typically less than 2 cm in diameter. Yet, certain cysts can develop and result in minor symptoms, including dyspareunia (difficult sex), loss of control of urine or feces, and slight discomfort in the lower abdomen (such as vaginal pressure or pelvic pain). Rare incidences of big cysts have been reported that made vaginal delivery challenging.
Notably, urethral diverticulum, the formation of pockets along the urethra, and ectopic ureter, a ureter that does not connect to the bladder and drains to a different site, are frequently associated with congenital malformations of the urinary tract, such as ipsilateral renal agenesis, or the absence of the kidney on one side, renal dysplasia, or the atypical development of the kidney.
How Is a Cyst in the Gartner Duct Detected?
A thorough gynecological examination of the patient and a study of their medical history are necessary to detect a Gartner duct cyst. A cyst may be found by gently palpating the vaginal wall, particularly the anterolateral wall. On the other hand, the speculum exam may provide a good view of the vaginal walls and make a cyst more visible. Other imaging techniques can be performed to accurately depict the cyst and its boundaries, such as an ultrasound, CT scan, or MRI. Fluorescein dye injections are crucial for establishing the connection between the urinary system and the Gartner duct cyst.
How Is the Cyst Treated?
It is only advised to treat Gartner duct cysts when symptoms are severe. Intracystic tetracycline sclerotherapy and cyst drainage are frequently used as treatments in moderate symptomatic instances. In more severe situations, surgical cyst removal is advised and is possible by utilizing various methods. The most effective method in minimizing the risk of recurrence is the complete surgical extraction of the cyst. Alternatively, a procedure known as cyst marsupialization can be performed, wherein the edges of the incision are sutured together to form a continuous opening, enabling free drainage of excess fluid.
What Are the Key Details of Gartner Duct Cysts?
Cystic lesions known as Gartner duct cysts generally develop in the vagina's anterolateral wall. They originate from the residual Wolffian duct tissue that does not entirely regress in people born with the gender ascribed to them. Most of these vaginal cysts are benign and only cause minor discomfort. GDCs are commonly accompanied by urinary tract abnormalities, potentially hindering therapeutic choices. The diagnostic value of a physical examination can be increased by further imaging. The optimum course of therapy is the surgical removal of the vaginal cyst; however, this is only essential in cases of severe symptomatology.
Conclusion
The studies demonstrate that conservative therapy might be a secure alternative for asymptomatic individuals, despite the modest number of instances with Gartner's cysts. However, more research, including a greater number of women in older age groups, is required for a more accurate characterization of behavior for these patients.
