Study design, materials and methods
We retrospectively reviewed a prospectively maintained database of 16 consecutive women of median age 35 [range 17-54] having surgical excision of paraurethral cysts between October 2011 and April 2017 for presenting symptoms, surgical management and outcomes.
15 (93.8%) women presented with a palpable vaginal lump. Other complaints included dyspareunia, vaginal discharge and voiding difficulty. 10 (62.5%) were referred with a clinical and MRI diagnosis of urethral diverticulum.
8 (50%) had urodynamic evidence of BOO consequent to their cyst, whilst 3 (18.8%) had evidence of detrusor overactivity (2 in association with BOO). All cysts were solitary and measured from 1.1 to 4.5cm in maximum dimension. 10 (62.5%) patients had cyst excision, 5 (31.3%) had cyst excision, repair of underlying adherent distal urethra and interposition of paraurethral tissue whilst 1 (6.3%) had cyst excision, repair of adherent mid and distal urethra and interposition of a modified Martius labial fat pad flap. The median follow-up period was 6 months (2.5-35). No complications or recurrences were demonstrated and presenting symptoms resolved in 15 (93.8%).
Interpretation of results
Paraurethral cysts are often mistaken both clinically and on MRI for urethral diverticulum. They cause similar symptoms and are associated with urodynamic abnormalities in > 50%. Complete excision resolves symptoms in 93.8% but may required urethral repair and tissue interposition in 37.6%.