Female patient, 32 years old, nulliparous, with no surgical history, was observed by a mass at the level of the anterior vaginal wall that conditioned voiding difficulty.
She had a long history of dysmenorrhea associated with menstrual irregularities up to about 5 years ago, when she started oral contraceptives due to the onset of sexual activity.
Two years ago she began progressively symptoms of dysuria, pelvic pain and dyspareunia with aggravation of the menstrual period associated with occasional urinary infections.
A year later he noticed an elastic and painful mass that was insinuated at the level of the vaginal vestibule.
The study revealed a cystic lesion that was submitted to aspiration with exit of content stricture.
The cytological study was inconclusive.
After a transient and initial improvement of symptoms that lasted a few months, there was an aggravation of the perimenstrual pelvic pain, dysmenorrhea, urethral pain and dysuria.
The anterior vaginal mass increased in size and for suffering vaginal protrusion, it became conditioning increasing difficulty in the beginning of the micturition with increased voiding effort, decreased jet force, intermittent needing digital reduction by the patient.
The objective examination revealed an elastic mass, very painful, well-defined, about 3-4 cm, located in the anterior vaginal wall and inserted into the vaginal introitus.
Pelvic MRI identified a rounded, well-defined lesion, located posteriorly to the urethra of 3.9x2.9x3 cm., with hypersignal on T1 and T2 suggesting that cystic fat content remains hemorrhagic.
The diagnostic suspicion is a complicated urethral diverticulum of infection and hemorrhage or an endometrioma.
Endovenous urography revealed normal excretory evidence of ureteral duplication.
A regular subtraction image at the level of the bladder floor is barely identified.
Urethrography did not document the presence of any communication with the urethra.
The patient underwent urethrocystoscopy under anesthesia, which did not reveal a diverticular ostium. The mass was then resected transvaginally.
The entire wall extending to the level of the bladder neck was resected and no communication with the urethra was documented.
The lesion contained dark chocolate liquid and thick chocolate liquid.
Anatomopathological examination showed endometriosis.
In the immediate postoperative period she had a transient period of mild urinary incontinence (related to urgency and moderate effort) that resolved with anticholinergic treatment and pelvic exercises.
1.
She underwent adjuvant treatment for 6 months with triptorelin 3.75 mg monthly: Currently she is asymptomatic and without evidence of recurrence.
