Surgical treatment of a superficial vulvar or paraurethral cyst (Bartholin gland cyst / Skene duct cyst)

Superficial vulvar and paraurethral cysts are cystic formations, generally benign, which may develop due to obstruction of a glandular duct and accumulation of secretions. Depending on their location, the service may include surgical treatment of a Bartholin gland cyst, located near the vaginal opening, or a Skene gland cyst, located paraurethrally, near the external urethral opening.

A cyst contains fluid and may remain asymptomatic for a long time. If it becomes infected, it may develop into an abscess, characterized by pain, swelling, local tenderness and, in some cases, fever or purulent discharge.

Anatomical structures

Bartholin glands are paired glands located on either side of the vaginal opening. Their secretion is released through small ducts and contributes to lubrication of the vulvovaginal area. Obstruction of the duct may lead to accumulation of secretions and cyst formation.

Skene glands, also known as paraurethral glands, are located near the distal portion of the urethra and the urethral meatus. Obstruction of their ducts may lead to the development of a paraurethral cyst. This may cause a sensation of a local mass, discomfort, pain, dyspareunia or urinary symptoms. Because some paraurethral formations may have a similar appearance, a Skene gland cyst should be differentiated particularly from a urethral diverticulum and other periurethral lesions.

Role of the service

The purpose of the intervention is to treat a symptomatic, persistent, infected or recurrent cystic formation by providing drainage or removing the formation, depending on the diagnosis and anatomical characteristics.

In the case of paraurethral cysts, an important objective is to accurately determine the relationship of the formation to the urethra and to exclude a urethral diverticulum before an intervention that could involve the periurethral structures. Ultrasound and, in selected cases, MRI or endoscopic evaluation may be useful for treatment planning.

Indications

Surgical treatment may be recommended when the cyst:

• causes pain, discomfort when walking or sitting, or pain during sexual intercourse;
• increases in size or causes local distortion;
• persists or recurs;
• becomes infected and forms an abscess;
• causes dysuria, changes in the urinary stream or other urinary symptoms;
• does not respond to conservative measures;
• has an atypical appearance or the diagnosis is uncertain;
• requires biopsy or histopathological examination.

Small, non-infected and asymptomatic Bartholin cysts do not always require surgical treatment. However, a new or atypical Bartholin gland mass requires medical evaluation.

Surgical Treatment / Procedure

The treatment method is selected by the surgeon based on the type and size of the formation, its location, the presence of infection, history of recurrence, and its relationship to the urethra.

For Bartholin gland cysts or abscesses, treatment may include drainage with a Word catheter or marsupialization. In selected cases, cyst excision may be indicated. Complete excision of the Bartholin gland is not the routine treatment for a simple cyst and is generally reserved for carefully selected cases, including recurrent cysts or situations in which more extensive histopathological evaluation is required.

For paraurethral / Skene gland cysts, treatment may consist of marsupialization or excision of the formation. The procedure is carefully planned to protect the urethra and to rule out beforehand any communication between the formation and the urethra.

The procedure may be performed under local, regional or general anesthesia. The type of anesthesia and the possibility of same-day discharge are determined individually by the surgeon together with the anesthesiologist.

Surgical treatment of superficial vulvar or paraurethral cysts aims to relieve symptoms, drain or remove the formation, and reduce the risk of recurrence and complications.

The exact type of intervention is determined only after consultation with a specialist.

The service is intended for the treatment of superficial vulvar and paraurethral cysts, including cysts of the Bartholin and Skene glands.
 

Sources:

https://www.nhs.uk/conditions/bartholins-cyst/
https://www.rightdecisions.scot.nhs.uk/maternity-gynaecology-guidelines/gynaecology/gynaecology-guidelines/guidelines-a-z-all-gynaecology-guidelines/management-of-bartholin-s-cyst-and-abscess-gynaecology-066
https://pmc.ncbi.nlm.nih.gov/articles/PMC3992454
https://radiopaedia.org/articles/paraurethral-duct-cyst
https://ceju.online/baza/tmp/man/man_993/ceju_993.pdf

IMPORTANT!

It is crucial to remember that the information provided in this section is not intended for self-diagnosis or self-treatment. If you experience pain or exacerbation of a condition, it is essential to consult a healthcare professional for diagnostic tests and appropriate treatment. Only a qualified specialist can provide an accurate diagnosis and determine the appropriate treatment plan. To obtain the most accurate and consistent evaluation of test results, it is recommended to have them performed at the same laboratory. This is because different laboratories may use different methods and units of measurement for similar tests.