What are the treatment options for a Skene (paraurethral) gland cyst?

Treatment of Skene Gland Cyst

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

Initial Management Approach

Asymptomatic Cysts

• Observation is appropriate for asymptomatic Skene gland cysts discovered incidentally, as these lesions rarely have clinical significance 3
• No intervention is required unless symptoms develop or the patient requests treatment 4

Symptomatic Cysts

• Surgical intervention is indicated when cysts cause:
  • Palpable vaginal mass causing discomfort 1
  • Urological symptoms (dysuria, urinary obstruction) 4
  • Gynecological complaints 4
  • Patient distress or cosmetic concerns 3

Surgical Treatment Options

Marsupialization (First-Line Surgical Treatment)

• This is the preferred technique for definitive management of Skene gland cysts 1, 2
• The procedure involves:
  • Incision of the cyst wall 1
  • Drainage of cyst contents 1
  • Suturing the cyst wall edges to the surrounding tissue to create a permanent opening 2
• Advantages include:
  • Simple procedure with low morbidity 1
  • Minimal recurrence risk 1
  • Excellent functional and cosmetic results 1
  • Streamlined approach that facilitates suture placement 2

Complete Excision

• Complete surgical excision is an alternative approach when marsupialization is not feasible 3
• Requires careful technique to avoid urethral injury 3
• Any urethral injuries identified during excision must be repaired immediately 3

Conservative Approaches (Select Cases Only)

• Puncture and aspiration may be considered in specific situations 5
• Spontaneous drainage can occur and may be appropriate in certain cases, particularly in neonates 5
• These conservative methods carry higher recurrence risk compared to marsupialization 5

Pre-operative Evaluation

Essential Workup

• Complete urinary tract evaluation is necessary before surgical intervention to exclude:
  • Urethral complications 3
  • More serious pathology 3
  • Associated urological abnormalities 3

Imaging Considerations

• MRI is useful for characterizing extensive cyst formations and defining anatomical relationships to the urethra 1
• Imaging helps confirm the diagnosis when clinical examination alone is insufficient 1

Post-operative Management

• Hospital discharge is typically possible within 1-2 days post-operatively 1
• Recovery is generally uneventful with proper surgical technique 1
• Long-term outcomes are excellent with no recurrence when marsupialization is performed correctly 1, 3

Special Population Considerations

Neonates and Infants

• Skene duct cysts occur in 1 in 2,000-3,000 female births 5
• The least aggressive technique appropriate for each case should be used in pediatric patients 5
• Spontaneous drainage may be acceptable in neonatal cases 5

Adolescents and Adults

• Surgical treatment is more definitive in older patients with persistent symptoms 5
• Marsupialization remains the preferred approach across all age groups when intervention is needed 2

Key Clinical Pitfalls

• Avoid misdiagnosis: Skene gland cysts can be confused with other anterior vaginal wall masses, Bartholin gland cysts, or urethral diverticula 4
• Do not overlook infection: If the cyst appears infected (erythema, tenderness, purulent discharge), it represents a Skene gland abscess requiring drainage and possible antibiotic therapy 6, 4
• Ensure proper anatomical identification: The Skene glands are located lateral to the urethra at the urethral meatus, distinct from Bartholin glands which are posterior at 4 and 8 o'clock positions 6