Doxycycline Sclerotherapy of a Symptomatic Paravaginal Mesonephric Duct Remnant

Abstract

Background A Gartner's duct cyst associated with a vaginal ectopic ureter is a rarely reported finding in the literature. Treatments for this anomaly include observation or surgical excision when symptomatic. Sclerotherapy is frequently used in the management of recurrent pleural effusions. One author has described the use of tetracycline sclerotherapy to successfully treat vaginal and vulvar Gartner's duct cysts. Our objective was to evaluate the effectiveness of doxycycline sclerotherapy in the treatment of a symptomatic Gartner's duct cyst associated with a vaginal ectopic ureter. Case A 17 year old nulligravid white female was referred for evaluation of a congenital gynecologic anomaly and a heavy vaginal discharge. She had been evaluated previously for gross hematuria and was found to have a bicornuate uterus and congenital absence of the right kidney. Cystoscopic evaluation had revealed an ectopic right ureter that opened into a right paravaginal cavity. At laparotomy the ectopic ureter was ligated at the bladder, however, the paravaginal cavity could not be approached abdominally. The paravaginal mass was then explored, but not excised, via a vaginal approach. The patient subsequently experienced heavy vaginal leaking of a serous fluid from the ostomy that had been created vaginally. The drainage was sufficiently heavy to require continuous use of incontinence pads and to interfere with normal daily activities. At this point she was referred to our care. A Technetium-labeled Dimercaptosuccinic Acid (DMSA) renal scintigram demonstrated the absence of functional renal tissue around the paravaginal cavity, and communication to the bladder was ruled out by a fistulogram. This anomaly was believed to represent a Gartner's duct cyst that had previously been communicating with the bladder via an ectopic vaginal ureter. To avoid further surgical intervention. the symptomatic cavity was then treated medically with doxycycline sclerotherapy. One gram of doxycycline was mixed with 100 cc of normal saline and 20 cc of 1 % lidocaine to provide topical anesthesia. This solution was then infused into the paravaginal cavity via a hysterosalpingogram catheter where it remained for 1–2 hours on three separate occasions over a 3 month period. The patient noted a marked reduction in the amount of leaking from the paravaginal cavity, and did not experience any side effects or complications from this therapy. Conclusions We report for the first time the safe and successful use of Doxycycline sclerotherapy in the treatment of a Gartner's duct cyst associated with a vaginal ectopic ureter.