Skenes gland cyst causing urinary retention

Introduction

Skene`s gland also known as paraurethral glands are bilateral prostatic homologues glands. It was first discovered and described by Alexander Johnston Chalmers Skene in 1880. Paraurethral glands are located posterolaterally to the urethra. Embryologically derived from the urogenital sinus. Skene`s gland secretes a small amount of mucoid material which has a role in sexual stimulation and lubrication. The etiology of paraurethral cysts remains unknown. The obstruction of Skene's ducts as a result of infection or inflammation usually in response to skenitis, of which gonorrhea is the most common cause, or cystic degeneration of embryonic remnants of the paraurethral glands, have been assumed to be possible causes of paraurethral cysts. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of Skene's duct cyst in a female which presented with acute urinary retention secondary to the lateral displacement of meatus.

Case description

A previously healthy female presented to casualty with gradual onset of suprapubic pain, associating with a sudden onset of the inability to void for 6 hours. The patient was complaining of obstructive lower urinary tracts symptoms for 2 weeks. She had 3 uncomplicated normal full term vaginal deliveries with an unremarkable past medical or surgical history. Examination of the external genitalia revealed an ovoid, fluctuant, tender swelling located just inferior to pubic symphysis and completely displacing and stretching the external urethral meatus to the opposite side. Compression of the swelling did not result in fluid extravasation through the urethra. Vaginal patency was also verified. Insertion of 14 Fr foley’s catheter was managed with difficulty and drained 600cc clear urine. MRI showed normal kidneys, ureters and urinary bladder with a simple 2.1x2.7x3.3cm lower vaginal cyst with high protein/hemorrhagic content mostly a paraurethral gland duct cyst. Patient underwent examination under anesthesia, cysto-urethroscopy and skene’s duct cysts excision was done. Histopathology examination displayed the presence of benign cystic lesion lined by transitional and squamous epiltleium with focal surface ulceration; thereby confirming the diagnosis of paraurethral cyst. Foley’s catheter was removed after 5 days and she voided freely.

Results and conclusions

Skenes gland cyst should be listed in the differential diagnosis of a female patient who comes with an acute urinary retention.