Skene氏管囊腫：女性膀胱出口阻塞之罕見病因

洪紹綸¹、吳俊賢^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Skene’s Duct Cyst: An Uncommon Cause of Female Bladder Outlet Obstruction

Leo Shao-Lun Hung¹, Chun-Hsien Wu^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Abstract

Female bladder outlet obstruction (BOO) is an overlooked disorder with ambiguous clinical symptoms. It can be caused by functional or anatomical disorders. Skene’s duct cyst is an uncommon etiology of anatomical female BOO.

We present a 70-year-old woman with acute urinary retention. The transabdominal ultrasound revealed a distended urinary bladder with a suspicious cystic lesion over the infra-vesical area. On pelvic examination, one nontender elastic mass about 3 cm in diameter over anterior vaginal wall was identified. Neither pus nor urine leakage from urethral meatus was noted by compressing the mass. There was neither pelvic organ prolapse nor urethral meatal tumor. Pelvic magnetic resonance imaging was performed and disclosed a cystic lesion (3 x 3 x 3.4 cm) encircling the full length of urethra. Further transrectal ultrasound examination showed the same findings. The unique walnut shaped peri-urethral cyst mimicked a “female prostate” on the image studies.

We underwent cystoscopy for her, and the results revealed neither urethral stricture nor diverticular ostium over the urethra was identified. Under spinal anesthesia, needle aspiration of the peri-urethral cystic lesion was performed, and 9 ml of cloudy yellowish fluid was drained out. Transvaginal marsupialization of the cystic lesion was then carried out. The cytology examination of the cystic fluid was negative for malignant cell and positive for prostate-specific antigen immunohistochemical stain. Histopathological examination of an incised cystic wall showed a squamous epithelial lining without malignancy. The diagnosis of Skene’s duct cyst was certain based on the aforementioned clinical and pathological findings. She didn’t have urinary incontinence post-operatively, and the uroflowmetry showed a normal flow pattern with minimal residual urine amount. There was neither recurrent peri-urethral cyst nor voiding difficulty over two years of follow-up.