3-D Ultrasonographic Appearance of Two Intermittent Paraurethral Cysts: A Case Report

IntroductionIn the adult female, a cyst of the Skene's duct is a rare event that may be either the late consequence of a congenital abnormality or the result of a chronic acquired inflammation.AimTo report a case of bilateral paraurethral Skene's duct cysts.MethodsA young (32 years old), eumenorrheic (menstrual cycle of >25 and <35 days) woman complained of a 6-month intermittent scarce lubrication during intercourse and a sensation of a small intravaginal “extraneous” body. The patient was repeatedly assessed with a detailed history, with a bimanual pelvic examination and with bi- and tridimensional ultrasonographic and color Doppler analyses of the urethrovaginal space.Main Outcomes MeasuresTransvaginal two-dimensional ultrasonographic evaluation of internal genitalia, bladder, and urethra and three-dimensional analysis of the paraurethral structures.ResultsThe evaluation of the structures comprised in the urethrovaginal space evidenced two small (1.7 and 1.1 cm in the maximum diameter) anechoic cysts with some debris in the most declivous part, laterally displaced to the middle/distal urethra. The cysts disappeared after a medical therapy.ConclusionsA sudden reduction of the vaginal lubrication requires a prompt gynecological and ultrasonographic evaluation of the urethrovaginal space. Battaglia C, and Venturoli S. 3-D ultrasonographic appearance of two intermittent paraurethral cysts: A case report.     

Cysts of the vagina: Classification and clinical correlations.

The clinical and morphologic features, as well as the classification, of surgically excised cysts of the vagina were reviewed. Sixty-four cysts were available for study. Classification was principally along developmental grounds, based on histologic and histochemical features of cyst epithelium. Detection of epithelial mucus production reduced significantly the incidence of Gartner's duct (mesonephric) cysts, indicating that this is an uncommon lesion. Cysts of mullerian origin, lined mainly by endocervical and occasionally by fallopian tubal epithelium, comprised one-third of the cases. Inclusion cysts of surface mucosa constituted the most common, but usually a clinically insignificant, type of vaginal cyst. Dilation of paraurethral glands and ducts could not adequately explain all the several cysts lined by urothelium. These lesions were difficult to distinguish on clinical grounds, alone, although mullerian cysts were nor symptomatic, due to their greater size.     

Congenital paraurethral cysts in two newborn girls: differential diagnosis, management strategies, and spontaneous resolution

BackgroundAt least five types of interlabial masses of different etiologies may present in a female neonate. The more serious type of interlabial mass must be differentiated from the benign and self-resolving paraurethral or hymenal cyst. Clues include appearance and color of the mass and the location of the mass in relation to the urethral meatus and the vaginal opening. Clinicians should be able to distinguish lesions that require aggressive intervention, i.e. surgery, from those that self-resolve and merely require observation.CaseTwo unrelated newborn girls each had a protruding faint-yellow-colored spherical interlabial cyst. The cyst was located anterior to the vaginal orifice and partially obscured the urethral meatus. Neither girl had any voiding problems. No other congenital anomalies were detected. Both cysts resolved rapidly and completely without surgical intervention.Summary and ConclusionParaurethral cysts of the newborn and hymenal cysts rarely cause urinary obstruction or spotting, and are self-resolving. When positively identified, no evaluation of upper urinary tract is required and neither aspiration of cyst contents or marsupialization procedure is necessary.     

Magnetic Resonance Imaging of Female Prostate Pathology

IntroductionThe female prostate (paraurethral glands) is a well-known, yet poorly understood, anatomic structure. Imaging studies of the female prostate, its physiology, and pathologies are still highly controversial.AimTo study the anatomy of the female prostate with contemporary magnetic resonance imaging (MRI) techniques and correlate these findings to clinical features.Main Outcome MeasuresFemale prostate pathologic anatomy on MRI.MethodsWomen with clinical signs of function (or dysfunction) of paraurethral glands have been examined with 1.5 or 3 Tesla MRI and urethroscopy.ResultsSeven women aged 17 to 62 years (median 40 years) have been prospectively included into the study. Clinically, one of the seven women reported ejaculation at orgasm, whereas three women presented with occasional secretions independent of sexual stimulation. In two women, paraurethral glands have been randomly found on MRI that has been performed in the diagnostic workup of other diseases. One woman presented with swelling of the external urethral meatus at puberty. In this woman, a paraurethral gland has been found, besides the erectile tissue at the external meatus. Two women reported lower urinary tract symptoms (LUTS) with mainly urethral symptoms (recurrent infections in one and paraurethral stones in the other). On MRI, paraurethral glands could be visualized in six of the seven patients. There was no relation between glandular volume and ejaculation status. In cases where glands or related pathologies could be found on physical examination, there was a clear correlation with MRI anatomy.ConclusionsMRI has the potential to become the standard imaging modality for female prostate pathology. Exact visualization of this highly variable structure is possible by tailored MRI protocols. This tool can aid in understanding an individual woman's symptoms related to paraurethral glands with an impact on her sexual life. Wimpissinger F, Tscherney R, and Stackl W. Magnetic resonance imaging of female prostate pathology. J Sex Med 2009;6:1704–1711.     

Paraurethral abscess developing after mid-urethral Zuidex-injection in women with stress urinary incontinence -- management of complications and retrospective comparison with bladder neck located injection technique

PURPOSE: To evaluate the cause and management of paraurethral abscess developing after injection of a mixture of hyaluronic acid and dextranomer (Zuidex) for treating stress urinary incontinence. PATIENTS AND METHOD: A total of 127 women having undergone midurethral Zuidex injection and 34 women after endoscopically guided Deflux injection into the tissue around the bladder neck were followed up 1 to 24 months after the intervention. At follow-up, the paraurethral tissue was evaluated clinically by gynecologic examination and by introital ultrasound. RESULTS: Thirteen of 127 women (10 %) having undergone midurethral Zuidex injection had a sterile paraurethral abscess that was treated by transvaginal puncture (1 to 3 punctures with removal of 10-60 ml of fluid per patient). No case of postoperative paraurethral abscess formation was demonstrated in the control group treated by Deflux injection into the area around the bladder neck. CONCLUSIONS: Paraurethral abscess must be excluded in the postinterventional follow-up of patients after Zuidex injection. Patients in whom an abscess is demonstrated can be treated by transvaginal puncture. Abscess formation can be avoided by injecting dextranomer/hyaluronic acid into the area around the bladder neck.     

人参皂甙Rg1对压力性尿失禁患者尿道旁筋膜成纤维细胞增殖的影响

目的 研究人参皂甙Rgl对体外培养的压力性尿失禁(SUI)患者的尿道旁筋膜成纤维细胞增殖的影响.方法 选择2006～2007年行尿道中段悬吊术的SUI患者术中切取的阴道前壁组织4份.剔除黏膜层,组织块培养法于体外培养尿道旁筋膜成纤维细胞,胰蛋白酶消化传代3-5代后,将细胞分为4组,分别加入5、10、20μmol/L人参皂甙Rg1及培养液,采用四甲基偶氮唑蓝比色法检测不同浓度人参皂甙Rg1培养24、48、72 h后的细胞增殖率,采用免疫组织化学法检测人参皂甙Rg1培养48 h后增殖细胞核抗原(PCNA)的表达.结果 (1)加入5、10、20 ttmol/L人参皂甙Rg1培养72 h后,各组的细胞增殖率分别为(29±5)%、(40±5)%、(26±4)%,分别与对照组(0)比较,差异均有统计学意义(P<0.01);10 μmol/L组分别与5 μmol/L组、20 μmol/L组比较,差异也均有统计学意义(P<0.01);但5 μmol/L组与20 μmol/L组比较,差异无统计学意义(P>0.05).(2)同一浓度人参皂甙Rg1组培养48 h后的细胞增殖率与培养24 h时比较,差异均有统计学意义(P<0.01);培养72 h后与培养48 h时比较,差异也均有统计学意义(P<0.01).(3)5 μmoL/L组、10 μmol/L组及20 μmol/L组培养48 h后的PCNA阳性率分别为49.24%、83.48%和54.50%,分别与对照组(28.77%)比较,差异均有统计学意义(P<0.01);10 μmol/L组与5μmol/L组、20 μmol/L组分别比较,差异也有统计学意义(P<0.01).结论 人参皂甙Rg1可促进体外培养的SUI患者尿道旁筋膜成纤维细胞的增殖.     

Paraurethral cyst as an unusual cause of acute urinary retention. A case report

Acute urinary retention occurs rarely in women. Previously reported causes include anatomic defects, perineal pain, behavioral disturbances and psychiatric disorders. A patient presented with acute urinary retention secondary to an infected paraurethral cyst.     

Connective tissue in female urinary incontinence.

An effective closure of the female urethra in stress situations is dependent on an integrated action of various anatomical structures connected to the organ. The most important of these structures - from a functional aspect - are the suburethral vaginal wall, the pubourethral ligaments, the pubococcygeus muscles and the paraurethral connective tissues. In all these structures connective tissue is an essential ingredient. Hence, defects in the actual connective tissue - in particular the paraurethral connective tissue that connects the aforementioned structures to each other and to the urethra - will bring about an ineffective urethral closure. Female urinary incontinence may then be caused by defective connective tissue per se and/or by a disconnection of the aforementioned structures, whereby the urethra cannot be 'kinked' - that is, closed off in stress situations.     

Adenocarcinoma of the paraurethral glands: Report of a case

A case of adenocarcinoma of the urethra originating in the paraurethral glands is reported. A method of therapy has been outlined. Review of the literature shows the rarity of the lesion in which only 50 cases have been reported.     

压力性尿失禁患者尿道周围结缔组织中核心蛋白聚糖mRNA表达水平与Ⅲ型胶原含量的相关性研究

目的探讨压力性尿失禁(SUI)患者尿道周围结缔组织中,核心蛋白聚糖(DCN)mRNA表达水平及Ⅲ型胶原含量变化及其相关性。方法将43例绝经前后妇女根据是否存在SUI分为SUI组(20例)和对照组(23例)。应用免疫组化法检测两组妇女尿道周围结缔组织中Ⅲ型胶原含量(以免疫组化指数表示);RT-PCR法检测DCNmRNA表达水平[以DCN与β肌动蛋白吸光度(A)值的比值表示]。结果SUI组患者尿道周围组织中DCNmRNA表达水平为0.76±0.16,对照组为0.76±0.16,两组比较,差异有统计学意义(P<0.05);SUI组患者Ⅲ型胶原含量为23±4,对照组为34±6,两组比较,差异也有统计学意义(P<0.05)。SUI组患者尿道周围组织中Ⅲ型胶原含量与DCNmRNA表达水平呈显著负相关(r=-0.720,P<0.05)。结论(1)尿道周围结缔组织中Ⅲ型胶原含量减少,可能是SUI发生的原因之一;(2)SUI患者尿道周围结缔组织中Ⅲ型胶原含量减少可能是由于局部DCNmRNA表达增强所致;(3)DCNmRNA表达增强,可能通过影响结缔组织的胶原含量和弹性性能参与SUI的发生。     

A rapidly growing paraurethral myoma with profuse bleeding from a mucosal vessel: report of a case

Paraurethral leiomyoma is rare. This is the first reported case of a woman with a 6 x 7 x 5 cm urethral leiomyoma with profuse vaginal bleeding. The site of bleeding was identified as the anterior vaginal mucosal vein, which we subsequently electrocauterized. Enucleation of the mass was performed smoothly with a Foley catheter to avoid damage to the urethra. Profuse bleeding from a paraurethral myoma is possibly due to increased vascularity and the prolapsed nature of the tumor in this area.     

Volume sonography of the pelvic floor in nulliparous women and after elective cesarean section.

OBJECTIVE: To describe the sonographic appearance of the pelvic floor which has not been stressed by forces of labor or vaginal delivery in pregnant women and after childbirth. SUBJECTS AND METHODS: In a prospective observational study 14 nulliparous women during first trimester pregnancy and 26 primiparous women after elective cesarean were examined within the first week postpartum. The integrity of the internal anal sphincter expressed as the ratio between the anterior and the posterior internal anal sphincter muscle thickness (a/p-ratio), asymmetry of the levator ani muscle and the paraurethral fixation of the lateral vaginal edges at the arcus tendineus were assessed using volume sonography. RESULTS: The a/p-ratio in nulliparous women was significantly higher (p<0.01) than after elective cesarean section. Asymmetry of the levator ani muscle did not differ between both groups but was more frequently in the nulliparous patients with an odds-ratio of 1.16 (CI 0.74-1.82). In both groups of women the paraurethral fixation of the lateral vaginal edges were above the suburethral level of the vagina. CONCLUSIONS: This study gives sonographic features of the pelvic floor in nulliparous women and in primigravidae after elective cesarean section. Data from the post-cesarean group can serve as reference values for further studies evaluating pelvic floor damage after various modi of vaginal delivery.     

Reconstruction of the pubovesicocervical fascia following surgical failures of the anterior vaginal wall

Results of reconstruction of fascia pubo-vesico-cervicalis in 21 women are presented after operative failure on the anterior vaginal dropped wall. The former operation consisted of anterior incision, separation of the walls to the sides, vesical intussusception with purse-string suture or transverse suture and of application mattress sutures on paraurethral tissue. At present the reconstruction of selected fascia pubo-vesico-cervicalis based on the doubling like a waistcoat and suturing under the symphysis pubis. Such a management causes a correctly fibrous and connective tissue support for urinary bladder and elevates the cervix upwards.     

Lithiazis in the periurethral gland of a woman

We present a very rare case of stone formation in the periurethral gland of a 49-year-old woman who was referred to our hospital with suspicion of a malignant or granulomatous soft-tissue lesion in the paraurethral area. The lesion was excised and the histopathological examination revealed cystic dilatation and squamous metaplasia in the lining of the glandular structure and surrounding lymphocyte infiltration. The scanning electron microscope examination of the stone revealed egg shell-like stratified concentric calcifications. The chemical composition revealed by the X-ray diffraction technique was a mixture of calcium oxalate and phosphate similar both at the outer and inner layers.     

Paraurethral Cyst in a Newborn: Case Report and Discussion

BackgroundParaurethral cyst is a rare cause of interlabial mass in neonates with an incidence of 1 in every 2000-7000 live births and represents less than 0.5% of congenital malformations of the urinary tract.CaseWe report the case of a paraurethral cyst in a neonate, which regressed spontaneously during follow-up without complications.Summary and ConclusionParaurethral cyst should be considered in the differential diagnosis of interlabial masses in newborns. Because of the high probability of spontaneous regression, expectant management appears to represent the management of choice.     

Urethral diverticulum as a cause for chronic genitourinary pain: a case report

A 53-year-old woman suffering for 20 years from chronic genitourinary pain was seen in our urogynecological unit. Quality of life assessment by King's Health Questionnaire showed a highly negative impact on quality of life. Clinical examination revealed a painful and swollen distal urethra, and a small fistula was seen located 12 mm proximal to the meatus externus. Perineal ultrasound and magnetic resonance imaging showed multiple cystic formations bilaterally located in the suburethral and paraurethral regions. A diverticulectomy was performed using the vaginal approach. Twelve months after surgery the woman is completely satisfied and only complaining about slight alguria.     

Vaginal atresia and cryptomenorrhea.

Six cases of congenital vaginal atresia are described. Three of these patients had cryptomenorrhea while the other 3 had severe coital difficulties. Despite the fact that normal coitus was impossible in these 3 women, 2 of them achieved successful pregnancies and had to be delivered by emergency cesarean section followed by resection of the occluding membranes. The third patient (with dyspareunia) resorted to paraurethral coitus for more than 2 years before seeking advice. The management of vaginal atresia proved difficult because of the recurrence of stenosis at the site of the excised membrane. This was particularly marked in the young adolescent females not exposed to regular coitus. An operative method that could minimize this complication is discussed.     

Neue Techniken in der Inkontinenzchirurgie

Urodynamic and morphologic follow-up studies have improved the understanding of the action of different surgical procedures for the treatment of urinary incontinence. Objective measurements and subjective estimations of improvement of quality of life have demonstrated the superiority of colposuspension and sling procedures, whereas vaginal repairs and needle suspensions can no longer be recommended as basic procedures. While tension-free vaginal tape (TVT) can be regarded as a real innovation, the different modifications of needle suspensions with ready-to-use sets of bone anchors and screws disregard the disadvantages of fixation in the paraurethral area. There seems to be a strict indication for peri- and intraurethral injections in selected patients with multiple failures and hypotonic or atonic urethra, but not as a primary procedure. Surgical traditions and problems of reimbursement are major reasons for paramedical decision making.     

卵巢囊肿患者手术指征的探讨

目的 :探讨卵巢囊肿患者的手术指征。方法 :诊治单纯囊肿患者 2 2 1例 ,其中最大径 <5cm 76例、≥ 5cm 14 5例。 184例施行了腹腔镜手术 ,37例施行了剖腹手术。结果 :病理学分析无 1例恶性。单纯囊肿、卵巢冠囊肿和黄体囊肿最大径在 <5cm和≥7cm者中的发生率分别为 90 .8%和 6 0 % ,二者差异有显著性 (P <0 .0 1)。单纯囊肿 ,卵巢冠囊肿和黄体囊肿在绝经前和绝经后者中的发生率为 81.5 %和 84 .0 %。结论 :最大径≥7cm的卵巢囊肿应及时手术 ,<7cm者可短时间观察 ,如囊肿持续存在 ,则应手术。绝经后者的卵巢囊肿应及时手术