[84] Management and outcome of peri-urethral lesions

Objective

To present a series of cases of peri-urethral lesions that presented to the urology and gynaecology department over the last 5 years. Peri-urethral lesions are unusual presentation to uro-gynaecology clinics. Clinical diagnosis can be challenging due a broad differential including urethral diverticulum, caruncle, prolapse, peri-urethral cyst, vaginal wall cyst, and neoplasms of urethral or vaginal origin.

Methods

A retrospective review of all patients who presented with peri-urethral lesions between November 2013 and June 2018. Data collected included presenting signs and symptoms, preoperative assessment, imaging, surgical management, and outcome.

Results

In all, 26 patients were identified (age range 24–83 years). The most common presenting symptom was vaginal pain ± dyspareunia in 18/26 (69%). In eight of the 26 (31%) the main symptom was a vaginal lump, seven (27%) had recurrent urinary tract infections, four (15%) had stress urinary incontinence, three (12%) had voiding dysfunction, and one (4%) was asymptomatic. On clinical examination, all patients were found to have a solitary vaginal lump measuring 1–4 cm. Five (19%) patients were treated conservatively. In all, 21 (81%) had trans-vaginal complete excision. Histological examination confirmed the diagnosis of urethral diverticulum in 15 patients (58%), Skene’s duct cysts in three, and Müllerian cyst and arterio-venous malformation one of each. There were no significant postoperative complications. Magnetic resonance imaging (MRI) findings did not match the histological diagnosis in nine of the 26 (35%) patients. The median follow-up period was 6 months and 10/21 (48%) had complete resolution of their symptoms. Five of 21 (24%) patients had persistent pain and have been treated conservatively by the pelvic floor physiotherapist or pain team, three of 21 (14%) had recurrent urinary symptoms and repeated MRI in two of them was negative. Three patients are still awaiting follow-up.

Conclusion

Peri-urethral lesions are uncommon but can be a challenging. MRI can be useful in diagnosis and to plan intervention, but in up to one-third the findings did not match the histological diagnosis. Surgical excision will alleviate symptoms with a small risk of recurrence of symptoms.