V2-06: Skene’s gland cyst excision

Video

Introductions and Objectives
To review our experience with the long-term outcome after Skene’s gland cyst excision

Methods
A surgical database of all procedures performed by two surgeons at one institution was reviewed for Skene’s gland cyst excision. Data extracted from an electronic medical record or medical charts were presenting symptoms, pre-operative evaluation, site of excision, peri-operative complications, and clinical outcomes. Technique of surgical excision is presented in the attached movie, and includes cystoscopy, dissection of cyst wall from the floor of the urethra with scissors or bovie on low setting, distal urethroplasty as indicated, complete removal of the cyst wall, and primary vaginal wall closure. Urethral Foley catheter is left indwelling for 3-5 days afterwards and sexual function is resumed after completion of vaginal healing.

Results
From 2001 to 2013, ten women were studied. Mean age was 45 (range: 29 to 66). Presenting symptoms were: dyspareunia (4), urinary tract infections (4), vaginal mass (1) and voiding dysfunction (1), with half of women having more than one presenting symptoms. Evaluation included an MRI in all women, and a voiding cystourethrogram in 5 to exclude a urethral diverticulum. Skene’s gland cyst was observed on the left (5) or right (5) sides, with no cases being bilateral. No peri-operative complications were reported. All procedures were done on an outpatient basis. A distal meatoplasty was done in 2 women, and a urethral dilation in another 2. Mean follow-up was 3.5 years (range 3 to 96 months). One woman died of unrelated cause (stroke). Four women had mild stress urinary incontinence in follow-up years, one requiring pelvic floor therapy, the others simple observation. Two have been treated for occasional urinary tract infections. One underwent a distal urethroplasty 6 years later after a failed urethral dilation. Eight of ten women who were sexually active remained sexually active post-operatively.

Conclusions
Excision of Skene’s gland cyst is a safe procedure with acceptable long-term functional outcomes._x000D_ _x000D_ _x000D_ Excision of a Skene’s gland cyst is:_x000D_ a. A frequent vaginal procedure due to the large incidence of this condition_x000D_ b. A bloody procedure possibly requiring blood transfusion_x000D_ c. A delicate operation that can lead to distal urethral wall damage and possible meatoplasty (*)_x000D_ d. Similar to a urethral diverticulum removal and requiring closure of the urethral ostium_x000D_ e. Likely to recur even after complete excision of the gland linings

Funding: none