Cent. Eur. J. Med.

• 5(2) • 2010 • 243-245

DOI: 10.2478/s11536-008-0076-0

Central European Journal of Medicine

Paraurethral cyst: A case report

Case Report

Meltem Ceyhan1*, Mehmet Selim Nural1, Tülin Oztas1, İlkay Koray Bayrak1,
Riza Rizalar2
1
Department of Radiology, Ondokuzmayis University, Faculty of Medicine,
55139 Samsun, Turkey

2
Department of Pediatric Surgery, Ondokuzmayis University,
Faculty of Medicine, 55139 Samsun, Turkey

Received 19 April 2008; Accepted 9 September 2008

Abstract: P
 araurethral or Skene’s duct cyst is a rare cause of masses located in the inter-labial genitor-urinary region and their etiology is not fully
known. These congenital cysts may be diagnosed easily by inspection in the initial physical examination of the new-borne. Radiological
evaluation is helpful for differential diagnosis and in determining the proximal extension of the cystic pathology. Treatment alternatives
are needle aspiration and non-surgical follow-ups leading to a spontaneous regression and surgery. In this report the radiological find-
ings of a female newborn diagnosed with paraurethral cyst in US and MR examinations have been discussed.
Keywords: Paraurethral congenital cyst • Newborn’s non-malignant urogenital tumor • Skene’s duct cyst • Ultrasound • MRI

© Versita Sp. z o.o.

1. Introduction examination was performed and showed a cystic mass

with 17x15 mm size in the inter-labial region posterior
to the urethral orifice (Figure 2). Magnetic Resonance
Paraurethral or Skene’s duct cyst is a very rare congenital
Imaging (MRI) revealed a single cyst lied along the
anomaly in newborn females. It is considered to occur
urethral region separate from vagina and urethra
due to the obstruction of Skene’s duct adjacent to the
(Figure 3). Urinary bladder and both kidneys were
urethral orifice [1-5]. In this case report, the radiological
normal in the radiological imaging. She had immediate
and surgical findings of a newborn with paraurethral cyst
surgical intervention with a pre-surgical diagnosis of a
in the interlabial region of the orifice of the vagina are
paraurethral (Skene’s duct) cyst. After the excision of the
discussed in the light of the medical literature.
cyst, the diagnosis was confirmed histo-pathologically
with typical appearances.
2. Case report
A two day-old female full-term newborn who was the
3. Discussion
first child in the second pregnancy of a 28 year-old
Although the etiology of the paraurethral cyst is not
Turkish mother admitted to OMU Faculty of Medicine
fully known, they are believed to occur due to the
with a mass lesion in the orifice of the vagina (Patient
obstruction of Skene’s duct – adjacent to the urethral
ID #: 984091). The delivery was by a cesarean section
orifice – secondary to infections or other causes of
in full-term and the baby was born 3100 gr. with a good
inflammatory processes [6]. It is also proposed that the
APGAR score. The mother had no history of drug use or
excessive glandular secretions in fetus increased by
smoking, and no x-ray exposure during the pregnancy.
transplacentally transferred maternal sex hormones may
No pre-natal screening was noted. A cherry colored mass
lead to the formation of the cyst [7,8]. The exact incidence
in the vaginal orifice (inter-labial region) was detected
is not known, but it is a very rare pathology. For instance,
in physical examination (Figure 1). An ultrasound (US)

* E-mail: drmceyhan@hotmail.com
243
 Paraurethral cyst: A case report

Figure 1. The mass in the interlabial region is seen on the midline, Figure 2. US examination shows the proximal segment of the cyst
posterior to the urethral orifice. is seen to lie between the urethra and vagina. U:Urethra;
V:Vagina.

in their case review published in 2007, Fujimota and et

Paraurethral cyst diagnose easily by inspection in the
al. reported only 49 paraurethral cyst cases presented in
initial physical examination of the new-borne [1,10,11]. It
the English literature. They have also discussed their 5
appears in paraurethral region as an ovoid cystic mass
paraurethral cyst cases over a 5-year period [9]. These
with 6-30 mm diameter with typical discoloration. Ectopic
paraurethral cysts spontaneously disappeared within a
uretherocele, urethral prolapsus and most importantly
follow-up period of 3-10 months after birth without any
vaginal rhabdomyosarcoma should also be considered
surgical intervention. So far, he suggested non-surgical
for the differential diagnosis [1-4,11]. Ultrasound and
follow-up on these patients unless no potentially danger
MRI is helpful in the diagnosis, in determining the
of urinary obstruction foreseen. Soyer and et al. have
proximal extension of the cyst, in the assessment of
reported two other cases from Turkey most recently and
urinary obstruction and planning for the correctional
suggested a possible modulating effects of maternal
surgery. The conclusive diagnosis is confirmed with
hormones, specifically with estrogens [8]. Actually, the
histopathological examinations after surgery. However,
number of the reported cases is estimated to be far
spontaneous resolution has also been reported in
less than the real prevalence because of undetected or
paraurethral cysts [2,7,9].
underreported cases.
Figure 3. T2-weighted MRI examination. a) The part of the cyst extending to the pelvic area is clearly seen in the sagittal image. b) The position
of the cyst posterior to the urethra is shown in the axial image C: Cyst; Black arrow: Urethra.

244
M. Ceyhan et al.
Needle aspiration and excision have been used in
the treatment of paraurethral cysts and they both have
been reported to have equal success. In our case, cyst
excision was preferred and performed immediately
because of the size of the mass and to avoid the
obstructive urinary complications. The post surgical
period is uneventful and no complication was observed.
Microscopic pathological findings are consisted with the
presumptive clinical and surgical diagnosis with typical
multiply layer epithelial benign cells appearances.
References
[1] Bergner D.M., Paraurethral cysts in the newborn,
South Med. J., 1985, 78, 749-750
[2] Herek O., Ergin H., Karaduman D., Cetin O., Akşit
M.A., Paraurethral cysts in the newborns: a case
report and review of the literature, Eur. J. Pediatr.
Surg., 2000, 10, 65-67
[3] Fathi K., Pinter A., Paraurethral cysts in female
neonates. Case reports, Acta Pediatr., 2003, 92,
758-759
[4] Blavias J.G., Pais V.M., Retik A.B., Paraurethral cysts
in female neonates, Urology, 1976, 7, 504-507
[5] Cohen H.J., Klein M.D., Laver M.B., Cyst of the
vagina in the newborn infant, Am. J. Dis. Child.,
1957, 94, 322-324
[6] Lee N.H., Kim S.Y., Skene’s duct cysts in female
newborns, J. Pediatr. Surg., 1992, 27, 15-17
Paraurethral cysts in the newborn should always be
considered in the differential diagnosis of the masses
located in the interlabial region. As seen in the case
presented here, US and MRI examinations are quite
helpful in diagnosing the masses located in this region
and, if present, defining the concomitant pathologies,
and in the planning of the methods of treatment
alternatives.
[7] Wright J.E., Paraurethral (Skene’s duct) cysts in the
newborn resolve spontaneously, Pediatr. Surg. Int.,
1996, 11, 191-192
[8] Soyer T., Aydemir E., Atmaca E., Paraurethral cysts
in female newborns: role of maternal estrogens, J.
Pediatr. Adolesc. Gynecol., 2007, 20, 249-251
[9] Fujimoto T., Suwa T., Ishii N., Kabe K., Paraurethral
cyst in female newborn: is surgery always advocated?
J. Pediatr. Surg., 2007, 42, 400-403
[10] Merlob P., Bahari C., Liban E., Reisner S.H., Cysts
of female external genitalia in the newborn infant,
Am. J. Obstet. Gynecol., 1978, 13, 607-610
[11] Kimbrough H.M., Vaughan E.D., Skene’s duct
cyst in a newborn: case report and review of the
literature, J. Urol., 1977, 117, 387-388
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