What is the treatment approach for a Skene gland cyst?

Treatment of Skene Gland Cyst

For symptomatic Skene gland cysts, surgical marsupialization is the definitive treatment of choice, offering low morbidity, minimal recurrence, and excellent outcomes. 1, 2

Initial Management Approach

Asymptomatic Cysts

• Asymptomatic Skene gland cysts can be managed conservatively with observation alone, as they are benign lesions that may not require intervention 3, 4
• Follow-up with physical examination every 6-12 months for 1-2 years is appropriate for monitored cysts 3
• Routine screening can be resumed if the cyst remains stable during follow-up 3

Symptomatic or Enlarging Cysts

• Surgical intervention is indicated when cysts become symptomatic (causing pain, urinary symptoms, or palpable mass) or demonstrate growth on follow-up 1, 5
• If a cyst increases in size during observation, definitive treatment should be pursued 3

Surgical Management

Marsupialization Technique (Preferred)

• Marsupialization is the gold standard surgical approach: the cyst is incised, drained, and the cyst wall is exteriorized and sutured to the surrounding tissue 1, 2
• This technique has several advantages:
  • Simple procedure with low morbidity 1
  • Minimal risk of recurrence 1
  • Excellent functional results 1
  • Streamlined and efficient approach 2
• Patients typically have uneventful recovery with discharge on postoperative day 2 1

Complete Surgical Excision (Alternative)

• Complete excision of the lesion is an alternative approach, particularly for recurrent or complex cases 5, 6
• Success rate after initial excision is 88.2%, with overall success rate of 85.3% after all treatments 6
• Recurrence after initial excision occurs in approximately 30% of cases, but 88.8% of recurrences resolve with further therapy 6
• This approach requires careful attention to potential urethral injury and appropriate repair if needed 5

Management of Infected Cysts (Skene Gland Abscess)

• Antibiotics should be prescribed when signs of cellulitis or systemic infection are present 7
• After conservative measures (antibiotics, drainage) have failed, surgical excision is safe and effective 6
• Infected cysts require more aggressive management than simple cysts 4, 6

Diagnostic Workup Prior to Treatment

• Ultrasonography is the preferred initial imaging modality for characterizing the cyst 3
• MRI may be used for better soft-tissue characterization, particularly for large or complex lesions 1
• Complete urinary tract evaluation should be performed to exclude complications or other serious lesions 5
• High clinical suspicion is essential for accurate diagnosis of this rare condition 1, 4

Key Clinical Pitfalls to Avoid

• Do not overlook Skene gland cysts in the differential diagnosis of anterior vaginal wall masses, urological symptoms, or gynecological complaints 4
• Avoid incomplete excision when performing surgical treatment, as this increases recurrence risk 1
• Do not delay surgical referral for symptomatic cysts, as conservative management is unlikely to provide definitive resolution 5, 6
• Ensure appropriate gynecological referral from emergency settings for definitive treatment planning 4