Surgical management of Skene’s gland abscess/infection: a contemporary series

Lesser vestibular periurethral gland-like inflammation associated with lower urinary tract signs in a female dog

CASE DESCRIPTION

A 4-year-old female spayed mixed breed dog presented with a 2-year history of painful urination and recurrent hematuria.

CLINICAL FINDINGS

The dog had a large sensitive bladder, palpation of which was followed by painful urination. Pollakiuria accompanied by vocalization were noted during observation of voiding.

DIAGNOSTICS

Cystoscopy identified a focal, rounded expansion of epithelial tissue in the right lateral aspect of the urethral papilla containing purulent material consistent with an abscess. A sample submitted for culture yielded growth of Staphylococcus pseudintermedius and Proteus mirabilis.

TREATMENT AND OUTCOME

Purulent material was expelled by manual pressure during cystourethroscopy. Enrofloxacin (10 mg/kg PO q24h for 42 days) and carprofen (4.4 mg/kg PO q24h for 14 days) were initiated. Clinical signs resolved within 2 days.

CLINICAL RELEVANCE

Inflammation in the region of the lesser vestibular paraurethral glands should be considered as a differential for female dogs presenting with chronic dysuria.

Periurethral abscess etiology, risk factors, treatment options, and outcomes: A systematic review

Objectives

This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.

Materials and methods

After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.

Results

Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.

Conclusions

Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.

Large Cyst of Skene Gland: A Rare Perineum Mass

Objective  In this report we present a rare case of a large cyst of Skene gland in a female patient with a palpable vaginal mass persisting for at least 2 years. Case Report  A 67-year-old female admitted to the department of urology due to the presence of "a vaginal mass" for the past 2 years. A cyst of Skene's duct was suspected based on clinical manifestation and findings of magnetic resonance imaging showing an extensive cyst formation in the upper vaginal area and anterior to the urethra. Based on these findings, a decision for surgical removement of the cyst was made. The cyst was incised, drained, and marsupialized. The postoperative recovery was uneventful, and the patient was discharged on the second postoperative day. Conclusion  High clinical suspicion is important to reach this rare diagnosis. Partial excision and marsupialization of the cyst is a simple procedure with low morbidity, without recurrence, and excellent results.

Urethral Masses

Urethral and periurethral masses in women include both benign and malignant entities that can be difficult to clinically differentiate. Primary urethral carcinoma is rare and the optimal treatment modality may vary depending on the stage at presentation. Because cancer-free survival is poor, clinicians shouldhave a high index of suspicion when evaluating a urethral mass. Some benign-appearing urethral masses may be safely observed. Surgical resection is an effective option that should be used based on patient preference and symptoms, and for suspicious lesions.

Skene's gland cyst: a simple marsupialization technique

INTRODUCTION AND HYPOTHESIS

We present a simple approach to the marsupialization of a Skene's gland cyst.

METHODS

Our technique facilitates suture placement to exteriorize the cyst wall to efficiently treat a distal Skene's gland cyst and reduce the risk of recurrence.

CONCLUSION

Marsupialization is an accepted option for the surgical management of Skene's gland cyst. This technique is an effective and streamlined approach to Skene's gland marsupialization.

Skene's gland cyst excision

INTRODUCTION AND HYPOTHESIS

We review our experience with long-term outcome after Skene's gland cyst excision.

MATERIALS AND METHODS

After receiving institutional review board approval, we reviewed a surgical database of all procedures performed by two surgeons at one institution for Skene's gland cyst excision. Parameters evaluated include presenting symptoms, preoperative evaluation, excision site, perioperative complications, and clinical outcomes. The technique of surgical excision is presented in the accompanying video, and includes cystoscopy, dissection of cyst wall from the floor of the urethra, complete removal of the cyst wall, and primary vaginal-wall closure.

RESULTS

From 2001 to 2013, ten women underwent Skene's gland cyst excision. Mean follow-up was 3.5 years (range 3-96 months). Presenting symptoms were dyspareunia (4), urinary tract infections (4), vaginal mass (1), and voiding dysfunction (1). Five patients had more than one presenting symptom. To exclude urethral diverticulum, magnetic resonance imaging (MRI) was done in all patients and a voiding cystourethrogram in five. No perioperative complications were reported. A distal meatoplasty was done in two women. No recurrence occurred. Eight of ten women who were sexually active remained sexually active postoperatively.

CONCLUSIONS

Excision of Skene's gland cyst is a safe procedure with acceptable long-term functional outcomes.

Skene’s Gland Abscess

Skene’s glands are glands situated in the caudal two-thirds of the urethra. Infection of the gland by bacteria leads to inflammatory obstruction of the paraurethral ducts, causing the formation of a cyst or abscess. Patients typically present with dysuria, dyspareunia, vaginal discharge, and pain. On physical examination, a palpable mass is present and purulent material can be expressed from the ductal orifice. Clinical assessment of women with paraurethral gland symptoms is difficult, necessitating further evaluation with imaging. Recent advances in sonographic and magnetic resonance imaging have dramatically improved evaluation of the female urethra and the paraurethral glands, clarifying findings at physical examination and providing accurate road maps for surgeons. Even though magnetic resonance imaging is the gold standard, transperineal sonography is an emerging imaging technique that is being used to evaluate female urethral and periurethral disease in a more cost-effective manner.

Lesions of Skene glands and periurethral region: a review

The periurethral (Skene) glands may become involved by a variety of conditions. Mass-like lesions need to be distinguished from other lesions arising from the anterior vagina. Familiarity with these lesions will be helpful if a patient with a lesion of the Skene glands or periurethral region is encountered.