We present four patients of 28, 31, 33 and 42 years old respectively, being the youngest embassy of 26 weeks.
Two of them consult their gynecologist referred from their primary care physician for dysuria lasting 4-6 weeks, occasional dyspareunia and in recent days sensation of paraurethral mass.
The other two consult only their gynecologist to discover a paraurethral mass.
Two of them prior to their appointment with their gynecologist had been treated by their primary care physician with amoxicillin-clavulanate at a dose of 875/125mg for one week, obtaining a partial improvement of symptoms.
The gynecologist after performing an examination of the patients and showing the possible urethral involvement decides to refer patients to the urologist for a study of the genitourinary apparatus, diagnosis and treatment of this pathology.
The physical examination of all patients was completely anodyne, with no inguinal lymphadenopathy or external genital lesions; no excessive vaginal secretions were observed that made us suspect a possible infectious etiology.
In all four cases we found a smooth, painless, cystic, slightly fluctuating nodule with variable sizes (between 1x1 and 4.1x4, 3cm) attached to the distal urethra and that seemed to be part of it.
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We requested for all four patients a urine culture and vaginal secretions being in all cases negative for STD (N. Gonorrhoeae, Claparesis in one case, E.), and a.
We also requested in all cases a retrograde urethrocystography demonstrating in one case that the cyst of the Sken's gland caused a small urethral stricture without any clinical relevance.
The urethra was intact in all cases and the bladder had normal characteristics.
This allowed us to rule out the possibility of anomaly, the main reason given by the gynecologist to refer these patients.
Initially, we established a conservative treatment with hygiene, antibiotic therapy and unsuccessful drainage attempt, because we prepared patients manually for complete excision of the cysts under anesthesia.
We performed the surgeries under locoregional anesthesia, in two cases injecting in the blue cyst of methylene to delimit it well, and in the other two under direct vision, placing in all of them a sequel cyst to preserve the urethral discharge
We sent the specimens for pathological anatomy and sent the contents of the cysts to microbiology.
The results were always stratified squamous epithelium cysts, with well-formed basal lamina and prominent microvillis with hemato-purulent content (colate coated).
Microbiological analysis was also negative for all types of STD.
Two of the patients remained with the 18 Fr urethral catheter for one week to preserve the structure of the urethra, since in these two patients the cyst wall was intimately adhered to the urethral wall repair is resorbable.
After its removal and with a follow-up period of 8 months to 4 years, patients have asymptomatic episodes without showing any recurrence or fistulous complication.
