Does a tailored magnetic resonance imaging technique affect the surgical planning and outcomes for different cystic urethral and periurethral swellings in females? Seven years tertiary center experience

Wally Mahfouz,Mohamed Elbadry,Ahmed Moussa,Hebatallah Hassan Mamdouh Hassan,Marilena Gubbiotti

doi:10.1007/s00345-022-03973-w

Abstract

PurposeTo evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of female urethral and periurethral cystic vaginal swellings, with emphasis on postoperative surgical outcomes.Materials and methodsThis is a retrospective analysis of females complaining of periurethral and urethral cystic swellings referred to our tertiary center, who underwent MRI for preoperative planning in the period from January 2014 till January 2021, with a total number of 57 patients. Data retrieved from the medical records included: patients’ demographics, presenting symptoms and signs, preoperative radiological investigations, duration of symptoms, previous surgical intervention, detailed intraoperative data, postoperative complications, and postoperative follow-up.ResultsUrethral diverticulum was the commonest cystic lesion representing (64.9%) followed by Skene gland cysts in 14%, Mullerian cysts in 7%, Gartner cysts in 3.5%, and dermoid inclusion cysts in 10.5%. MRI precisely diagnosed the various pathological entities and anatomical complex lesions prior to surgery. This was confirmed after surgery and pathology analysis. All patients were followed up with a mean duration of 35 months, without any evidence of recurrence.ConclusionMRI as a standalone imaging technique is mandatory for diagnosis of all urethral and periurethral cystic lesions, as it offers the most accurate diagnostic modality for delineation of these lesions and hence aids in the preoperative surgical planning, aiming to avoid recurrence and improving surgical outcomes.

Highlights

Female urethral and periurethral cystic swellings are not a common pathology
There is a wide range of differential diagnoses of these cystic lesions, with urethral diverticulum (UD; the most common lesion), Skene duct cyst with classical juxtameatal location, and less commonly anterior vaginal wall cysts such
The objective of this study was to evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of different female urethral and periurethral cystic swellings, paying particular attention to the postoperative surgical outcomes

Summary

Introduction

Female urethral and periurethral cystic swellings are not a common pathology. Presenting symptoms are multiple, including vaginal fullness and discomfort, urinary symptoms including recurrent urinary tract infections (UTIs), urinary incontinence (UI), obstructive urinary symptoms, and discharging pus or urine from urethral meatus. Differentiating these lesions clinically is challenging due to symptoms overlap and difficulty in identifying the origin of these cystic swellings [1]. There is a wide range of differential diagnoses of these cystic lesions, with urethral diverticulum (UD; the most common lesion), Skene duct cyst with classical juxtameatal location, and less commonly anterior vaginal wall cysts such. The character and complexity of these diverticula together with their ostial communication must be accurately determined pre-operatively to improve post-surgical outcomes

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