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Subpubic Cartilaginous Cyst Presenting as Acute Urinary Retention: A Report and Review of the Literature

Ghareeb, George M. BS*; Grabemeyer, Heidi MD; Dietrich, Emily MD; Heisler, Christine A. MD, MS, FACOG, FACS

Female Pelvic Medicine & Reconstructive Surgery: January/February 2013 - Volume 19 - Issue 1 - p 58–60
doi: 10.1097/SPV.0b013e318278cd3b
Case Report

Introduction: A subpubic cartilaginous cyst is a rare and therefore poorly understood pathologic process involving the symphysis pubis. We describe a case of a postmenopausal female with acute urinary retention secondary to a periurethral cyst, and provide a literature review of previously reported cases of women with presenting complaints of a vulvar mass or pain. The differential diagnoses of a subpubic cartilaginous cyst, as well as management options, are discussed.

Case: A 68-year-old woman presented with acute urinary retention. Physical examination revealed a 4-cm tender cystic mass palpated along the anterior vaginal wall traversing toward the posterior pubic ramus. A pelvic magnetic resonance imaging showed a 4.4 × 3.5 × 4.2-cm3 well-circumscribed, cystic lesion at the anterior aspect of the lower urethra with no intrinsic contrast enhancement. The cyst was surgically excised through a transvaginal approach with no recurrence to date.

Conclusions: A subpubic cartilaginous cyst is an uncommon lesion thought to originate from the symphysis pubis and to be a result of degenerative changes. Patients have presented with pain, a vulvar/vaginal mass, or both. This case describes a patient who presented with acute urinary retention. In patients with suspected subpubic cartilaginous cyst, the lesion may be excised in symptomatic patient or observed in those who are asymptomatic. Standard of care has not yet been determined regarding management due to the rarity of the lesion.

Acute urinary retention resulting from a subpubic cartilaginous cyst was corrected with transvaginal surgical excision. Due to the rarity of these cysts, similar cases with management are included for review.

From the *Michigan State University College of Human Medicine; †Grand Rapids Medical Education Program, Department of Obstetrics and Gynecology, and Michigan State University; ‡Spectrum Health Medical Group, Department of Obstetrics, Gynecology and Women’s Health, Division of Female Pelvic Medicine and Reconstructive Surgery, Grand Rapids, MI.

Reprints: Christine A. Heisler, MD, MS, FACOG, FACS, Spectrum Health Medical Group, Department of Obstetrics, Gynecology and Women’s Health, Division of Female Pelvic Medicine and Reconstructive Surgery, 25 Michigan St, Suite 6200, Grand Rapids, MI 49503. E-mail: christine.heisler@spectrum-health.org.

The authors have declared they have no conflicts of interest.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins