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A 10-Year Case Series of Surgically Managed Periurethral Masses at a Single Tertiary Care Institution

Wyman, Allison M., MD*†; McDowell, Megan, MD; Prieto, Isabel, MD*†; Jackson, Elisha, MD*; Bassaly, Renee, DO*†; Ordorica, Raul, MD; Greene, Kristie A., MD*†

Female Pelvic Medicine & Reconstructive Surgery: November 8, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000651
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Objective This study aimed to present the evaluation, diagnoses, and surgical management of symptomatic periurethral masses of women at an academic institution.

Methods This study is an institutional review board–approved retrospective case series of women who presented with a symptomatic periurethral mass and scheduled for surgery within the Department of Urology and Female Pelvic Medicine and Reconstructive Surgery over a 10-year period (October 2003–July 2014).

Results Fifty-nine women (mean age, 46 years; range, 22–73 years) were evaluated during the study period. Final pathology revealed 38 (64%) urethral diverticula and 21 (36%) from other benign etiologies. Of the 38 urethral diverticula, 2 (5%) were associated with adenocarcinoma and 4 (11%) with previous bulking agents. Of the 21 nondiverticula, there were 7 (12%) Skene duct cysts/abscesses, 3 (5%) Gartner duct cysts, 2 (3%) vaginal wall inclusion cysts, 2 (3%) bulking agents, 2 (3%) urethral polyps, and one (2%) of each of the following: leiomyoma, angiomyofibroblastoma, redundant vaginal mucosa epithelium, suture abscess, and encapsulated mesh remnant. Fifty-seven women underwent surgical excision (97%), and 2 elected observation. Most (78%) reported resolution of symptoms after excision. Of the patients surgically managed, 7% had postoperative stress urinary incontinence and 12% had persistent lower urinary tract symptoms. Of the 38 women with urethral diverticula, 17% had recurrence and were more likely to have multiple diverticula (44% vs 8%, P = 0.03).

Conclusion Although urethral diverticulum was the most common cause of a periurethral mass, final pathology revealed a variety of benign diagnoses in more than one-third of cases, demonstrating the importance of a thorough investigation for accurate diagnosis.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery,

Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL; and

Department of Urology, Kaiser Permanente Anaheim Medical Center, Anaheim, CA.

Correspondence: Allison M. Wyman, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, STC Building, 6th Floor, 2 Tampa General Circle, Tampa, FL 33606. E-mail: awyman@health.usf.edu.

A.M.W. is a recipient of the 2017 Pelvic Floor Disorders Research Foundation Faculty Research Award. All other authors have declared no conflicts of interest.

The authors report no financial support for the research.

Paper Presentation Information: Poster presentation at Society of Gynecologic Surgeons Annual Scientific Meeting, Orlando, FL; March 2015.

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