Urology Annals
About UA | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionLogin 
Urology Annals
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 429   Home Print this page  Email this page Small font size Default font size Increase font size


 
Table of Contents
CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 3  |  Page : 204-205  

Paraurethral Skene's duct cyst in a newborn


Department of Pediatric Surgery, Zeynep Kamil Women and Child Diseases Education and Research Hospital, Istanbul, Turkey

Date of Submission18-Aug-2011
Date of Acceptance08-Oct-2011
Date of Web Publication29-Jul-2013

Correspondence Address:
Serdar Moralioglu
Arakiyeci Haci Mehmet Mah. Op. Dr. Burhanettin Üstünel Cad. No: 10 34668 Üsküdar, Istanbul
Turkey
Login to access the Email id


DOI: 10.4103/0974-7796.115754

PMID: 24049387

Rights and Permissions
   Abstract 

Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. 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 a Skene's duct cyst in a newborn which was treated by incision and drainage.

Keywords: Newborn, paraurethral cyst, Skene′s duct cyst


How to cite this article:
Moralioglu S, Bosnali O, Celayir AC, Sahin C. Paraurethral Skene's duct cyst in a newborn. Urol Ann 2013;5:204-5

How to cite this URL:
Moralioglu S, Bosnali O, Celayir AC, Sahin C. Paraurethral Skene's duct cyst in a newborn. Urol Ann [serial online] 2013 [cited 2017 Apr 27];5:204-5. Available from: http://www.urologyannals.com/text.asp?2013/5/3/204/115754


   Introduction Top


Paraurethral glands and ducts that empty into the vaginal vestibule close to the urethral meatus are rudimentary female homologs of the prostate, and the two largest of these ducts are known as Skene's ducts. [1] Paraurethral or Skene's duct cysts are a rare cause of interlabial mass in neonates. A cyst or abscess occurs, most commonly in the third and fourth decades. The exact incidence of Skene's gland cyst is unknown; however, one study has reported the incidence among neonates to be 1 in 2074 female births. [2] These cysts arise from the obstruction of the glandular ductus or cystic degeneration of embryonic remnants of the paraurethral glands. Thus, we report a case of Skene's duct cyst in a newborn which was treated by incision and drainage.


   Case Report Top


A healthy 12-day-old female infant was referred with interlabial mass. In patient's history, cystic mass was noticed soon after birth and its size did not change during this period. On examination, she had a soft, ovoid cystic mass, approximately 15 mm in diameter. It was located on the right side of the urethral meatus and the urethra was deviated to the left side [Figure 1]. Vaginal patency was also verified. Laboratory investigations included renal function tests, urinalysis, and complete blood count which were all normal. Urinary and pelvic ultrasounds and voiding cystourethrography were normal. Examination under anesthesia was performed. A Skene's duct cyst was identified. Urethral catheterization was done and the cyst was treated by incision and drainage [Figure 2]. Biopsy was not made. The remainder of the examination was normal. The microscopic evaluation of the fluid was normal and no bacterium was detected on culture. The postoperative course was uneventful. No recurrence was observed within 9 months after drainage.
Figure 1: Characteristic appearance of Skene's duct cyst in a female newborn

Click here to view
Figure 2: After drainage, the cyst disappeared and the urethral meatus returned to the midline position

Click here to view



   Discussion Top


Skene's gland was discovered and described by Alexander Johnston Chalmers Skene in 1880. [3] The paraurethral glands and ducts known to form as the outpouching of the urethra during the third gestational month are homologs of the male prostate. The paraurethral glands which are between 6 and 30 in number, have their own ducts that open just inside the urethral meatus. The largest two of these are the paraurethral glands of Skene. [2],[4] Skene's glands secrete a mucoid material with sexual stimulation, but in the newborns paraurethral glands infrequently respond to maternal estrogen and secrete a small amount of the mucoid material. [2] Skene's duct cyst is rare in any age group, especially in newborns. The precise etiology of paraurethral cysts is unknown. But the obstruction of Skene's ducts as a result of infection or inflammation, or cystic degeneration of embryonic remnants of the paraurethral glands, has been postulated.

The differential diagnosis of paraurethral Skene's duct cysts in newborns includes imperforate hymen, Gardner duct cyst, Mullerian duct cyst, urethral prolapse, rhabdomyosarcoma of the vagina, prolapsed ectopic ureterocele, condyloma, urethral polyp, congenital lipoma and vaginal prolapse. [1] The histologic appearance of the cyst epithelium identifies its embryologic origin. The vagina is derived from the paramesonephric (Mullerian) duct, the mesonephric (Wolfian) ducts and the urogenital sinus. The vaginal cysts are lined with stratified squamous epithelium, if they are originating from the Mullerian duct. Cysts derived from persistent mesonephric (Gartner's) ducts are lined with cuboidal epithelium. Finding a transitional epithelium in the cyst wall will confirm the origin to be in the urinary tract, since the distal vaginal wall, Skene's ducts, paraurethral glands, and urethra are all derived from the urogenital sinus. [5]

The diagnosis of a Skene's duct cyst in a newborn was based on its location in relation to the urethra or the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of the urethral meatus by the mass and a cyst containing milky fluid. Even though in our patient we had found that Skene's duct cyst had characteristic clinical findings which were helpful for diagnosis, we completed urological evaluation to differentiate Skene's duct cyst from other interlabial masses.

Treatment options vary from observation to surgery. Rarely, Skene's duct cysts require no drainage and resolve with time or rupture spontaneously. [6] However, most cysts require drainage. [2] Needle aspiration and incisional drainage of cysts are some of the options for treatment. Whenever examination under general anesthesia is not required, treatment can be performed under local anesthesia with a cream which contains lidocain. Partial excision of the cyst with marsupialization of its wall has been proposed as the treatment of choice for Skene's duct cysts in newborns. [7] We treated Skene's duct cyst successfully with only a small incision. Because complete or partial excision and marsupialization are more traumatic options than needle aspiration and incisional drainage, thus they should be reserved for adolescents and recurrent cases in newborns.

Finally, we believe that incision and drainage is a simple, safe, and effective method for the treatment of Skene's duct cysts in newborns.

 
   References Top

1.Nickles SW, Burgis JT, Menon S, Bacon JL. Prepubertal Skene's abscess. J Pediatr Adolesc Gynecol 2009;22:e21-2.  Back to cited text no. 1
[PUBMED]    
2.Lee NH, Kim SY. Skene's duct cysts in female newborns. J Pediatr Surg 1992;27:15-7.  Back to cited text no. 2
[PUBMED]    
3.Skene AJC. The anatomy and pathology of two important glands of the female urethra. Am J Obstet 1880;13:265-70.  Back to cited text no. 3
    
4.Huffman JW. The detailed anatomy of the para-urethral ducts in the adult human female. Am J Obstet Gynecol 1948;55:86-101.  Back to cited text no. 4
[PUBMED]    
5.Bergner DM. Paraurethral cysts in the newborn. South Med J 1985;78:749-50.  Back to cited text no. 5
[PUBMED]    
6.Cohen HJ, Klein MD, Laver MB. Cysts of the vagina in the newborn infant. AMA J Dis Child 1957;94:322-4.  Back to cited text no. 6
[PUBMED]    
7.Kimbrough HM Jr, Vaughan ED Jr. Skene's duct cyst in a newborn: Case report and review of the literature. J Urol 1977;117:387-8.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed15587    
    Printed79    
    Emailed1    
    PDF Downloaded371    
    Comments [Add]    

Recommend this journal