[84] Management and outcome of peri-urethral lesions

Objective: To present a series of cases of peri-urethral lesions that presented to the urology and gynaecology department over the last 5 years. Peri-urethral lesions are unusual presentation to uro-gynaecology clinics. Clinical diagnosis can be challenging due a broad differential including urethra...

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Autores principales:	Mustafa Hilmy, S. Faik, B. Vissamsetti, N. Dean, A. Evans
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/4c6d5b59a5c34c28a78dba343cb05a8d
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spelling	oai:doaj.org-article:4c6d5b59a5c34c28a78dba343cb05a8d2021-12-02T10:11:40Z[84] Management and outcome of peri-urethral lesions2090-598X10.1016/j.aju.2018.10.037https://doaj.org/article/4c6d5b59a5c34c28a78dba343cb05a8d2018-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18301311https://doaj.org/toc/2090-598XObjective: To present a series of cases of peri-urethral lesions that presented to the urology and gynaecology department over the last 5 years. Peri-urethral lesions are unusual presentation to uro-gynaecology clinics. Clinical diagnosis can be challenging due a broad differential including urethral diverticulum, caruncle, prolapse, peri-urethral cyst, vaginal wall cyst, and neoplasms of urethral or vaginal origin. Methods: A retrospective review of all patients who presented with peri-urethral lesions between November 2013 and June 2018. Data collected included presenting signs and symptoms, preoperative assessment, imaging, surgical management, and outcome. Results: In all, 26 patients were identified (age range 24–83 years). The most common presenting symptom was vaginal pain ± dyspareunia in 18/26 (69%). In eight of the 26 (31%) the main symptom was a vaginal lump, seven (27%) had recurrent urinary tract infections, four (15%) had stress urinary incontinence, three (12%) had voiding dysfunction, and one (4%) was asymptomatic. On clinical examination, all patients were found to have a solitary vaginal lump measuring 1–4 cm. Five (19%) patients were treated conservatively. In all, 21 (81%) had trans-vaginal complete excision. Histological examination confirmed the diagnosis of urethral diverticulum in 15 patients (58%), Skene’s duct cysts in three, and Müllerian cyst and arterio-venous malformation one of each. There were no significant postoperative complications. Magnetic resonance imaging (MRI) findings did not match the histological diagnosis in nine of the 26 (35%) patients. The median follow-up period was 6 months and 10/21 (48%) had complete resolution of their symptoms. Five of 21 (24%) patients had persistent pain and have been treated conservatively by the pelvic floor physiotherapist or pain team, three of 21 (14%) had recurrent urinary symptoms and repeated MRI in two of them was negative. Three patients are still awaiting follow-up. Conclusion: Peri-urethral lesions are uncommon but can be a challenging. MRI can be useful in diagnosis and to plan intervention, but in up to one-third the findings did not match the histological diagnosis. Surgical excision will alleviate symptoms with a small risk of recurrence of symptoms.Mustafa HilmyS. FaikB. VissamsettiN. DeanA. EvansTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss , Pp S39- (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Mustafa Hilmy S. Faik B. Vissamsetti N. Dean A. Evans [84] Management and outcome of peri-urethral lesions
description	Objective: To present a series of cases of peri-urethral lesions that presented to the urology and gynaecology department over the last 5 years. Peri-urethral lesions are unusual presentation to uro-gynaecology clinics. Clinical diagnosis can be challenging due a broad differential including urethral diverticulum, caruncle, prolapse, peri-urethral cyst, vaginal wall cyst, and neoplasms of urethral or vaginal origin. Methods: A retrospective review of all patients who presented with peri-urethral lesions between November 2013 and June 2018. Data collected included presenting signs and symptoms, preoperative assessment, imaging, surgical management, and outcome. Results: In all, 26 patients were identified (age range 24–83 years). The most common presenting symptom was vaginal pain ± dyspareunia in 18/26 (69%). In eight of the 26 (31%) the main symptom was a vaginal lump, seven (27%) had recurrent urinary tract infections, four (15%) had stress urinary incontinence, three (12%) had voiding dysfunction, and one (4%) was asymptomatic. On clinical examination, all patients were found to have a solitary vaginal lump measuring 1–4 cm. Five (19%) patients were treated conservatively. In all, 21 (81%) had trans-vaginal complete excision. Histological examination confirmed the diagnosis of urethral diverticulum in 15 patients (58%), Skene’s duct cysts in three, and Müllerian cyst and arterio-venous malformation one of each. There were no significant postoperative complications. Magnetic resonance imaging (MRI) findings did not match the histological diagnosis in nine of the 26 (35%) patients. The median follow-up period was 6 months and 10/21 (48%) had complete resolution of their symptoms. Five of 21 (24%) patients had persistent pain and have been treated conservatively by the pelvic floor physiotherapist or pain team, three of 21 (14%) had recurrent urinary symptoms and repeated MRI in two of them was negative. Three patients are still awaiting follow-up. Conclusion: Peri-urethral lesions are uncommon but can be a challenging. MRI can be useful in diagnosis and to plan intervention, but in up to one-third the findings did not match the histological diagnosis. Surgical excision will alleviate symptoms with a small risk of recurrence of symptoms.
format	article
author	Mustafa Hilmy S. Faik B. Vissamsetti N. Dean A. Evans
author_facet	Mustafa Hilmy S. Faik B. Vissamsetti N. Dean A. Evans
author_sort	Mustafa Hilmy
title	[84] Management and outcome of peri-urethral lesions
title_short	[84] Management and outcome of peri-urethral lesions
title_full	[84] Management and outcome of peri-urethral lesions
title_fullStr	[84] Management and outcome of peri-urethral lesions
title_full_unstemmed	[84] Management and outcome of peri-urethral lesions
title_sort	[84] management and outcome of peri-urethral lesions
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/4c6d5b59a5c34c28a78dba343cb05a8d
work_keys_str_mv	AT mustafahilmy 84managementandoutcomeofperiurethrallesions AT sfaik 84managementandoutcomeofperiurethrallesions AT bvissamsetti 84managementandoutcomeofperiurethrallesions AT ndean 84managementandoutcomeofperiurethrallesions AT aevans 84managementandoutcomeofperiurethrallesions
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[84] Management and outcome of peri-urethral lesions

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