Documentation Requirements for Skene Gland Cystectomy
For a Skene (paraurethral) cyst excision, you must document the preoperative evaluation findings, intraoperative cystoscopy results, complete dissection and removal of the cyst wall from the urethral floor, closure technique, and any concurrent procedures performed.
Preoperative Documentation
Essential preoperative elements to chart:
Presenting symptoms - Document specific complaints such as dyspareunia, recurrent urinary tract infections, palpable vaginal mass, or voiding dysfunction, as these are the most common presentations 1
Imaging confirmation - Record MRI findings to definitively exclude urethral diverticulum, which is critical for surgical planning 1. Some cases may also include voiding cystourethrogram results 1
Physical examination findings - Document the exact location, size, and characteristics of the cyst in relation to the urethral meatus 2, 3
Intraoperative Documentation
Critical operative details to record:
Cystoscopy findings - Document the cystoscopic evaluation performed at the start of the procedure to assess urethral integrity 1
Dissection technique - Chart the careful dissection of the cyst wall from the floor of the urethra, emphasizing complete removal of the cyst wall 1
Excision site and extent - Specify whether the cyst was located distally near the urethral meatus or more proximally, and document complete versus partial excision 1, 2
Closure method - Record the primary vaginal wall closure technique used 1
Concurrent procedures - Document if distal meatoplasty was performed, which may be necessary in approximately 20% of cases 1
Specimen handling - Note whether the cyst was completely excised, drained and marsupialized, or underwent puncture and aspiration 3
Postoperative Documentation
Essential follow-up elements:
Immediate complications - Chart any perioperative complications, though these procedures typically have low morbidity 1, 2
Functional outcomes - Document preservation of sexual function, as most sexually active patients remain so postoperatively 1
Recurrence monitoring - Note that long-term follow-up should track for symptom recurrence, which occurs in approximately 30% of cases after initial excision 4
Common Pitfalls to Avoid
Failing to exclude urethral diverticulum preoperatively - This is a critical differential diagnosis that requires imaging confirmation before proceeding 1
Incomplete cyst wall removal - Document complete excision of the cyst wall, as incomplete removal may contribute to the 30% recurrence rate 1, 4
Inadequate histological classification - Send the specimen for pathology to determine whether it is a Skene duct cyst, epithelial inclusion cyst, Müllerian cyst, or Gärtner duct cyst, as this may have etiological implications 5