AIM: To improve the examination of patients with chronic skenitis by developing and clinically testing a specialized retractor for visual inspection of the urethra and Skene glands.
MATERIALS AND METHODS: A total of 50 women aged 19 to 38 years, examined in the period 2021-2024 with a preliminary diagnosis of skenitis, were included in the study. The average duration of the symptoms was 8.6+/-3.6 years. This disease was suspected based on complaints, history and the palpation of the urethra, which revealed severe pain in the area of its distal and middle third, where Skene glands are located. All patients underwent two examinations of the urethra. The first evaluation was done according to the standard technique using tweezers, while during the second an original instrument was used. To determine the diagnostic efficiency of the examination, required time, the number of identified Skene's gland ducts, and the results of the assessment of the urethral mucosa (hyperemia, infiltration) were assessed. The safety of the examination was based on the evaluation of pain using a visual analogue scale (VAS) and the presence of clinically significant count of red blood cells in urine (more than 10 cells per field) in urinalysis collected immediately after the inspection.
RESULTS: In order to improve the visualization of the urethra, as well as the Skene's gland ducts, we developed an original tool, which is a urethral speculum (patent for invention of the Russian Federation No. 2790762 dated February 28, 2023). The median examination time and the number of identified Skene's gland ducts according to the standard technique were 287 sec (Q1-Q3 248-340) and 2 (Q1-Q3 2-2), respectively. When examining the same respondents with the original tool, the respective values were 139 sec (Q1-Q3 125-157) and 3.5 (Q1-Q3 3-4), respectively. Inflammatory changes in the urethra, including hyperemia of the mucosa and/or its infiltration when assessed using the conventional method were detected in 12 (24%) women, compared to 14 (28%) cases when a specialized retractor was used. Analysis of the diagnostic accuracy revealed that the duration of the examination and the number of ducts detected differed significantly between two methods (p<0.001). Hyperemia and/or infiltration of the urethral mucosa was equally common (2 = 0.167; p=0.684). The differences in the safety of new visualization method were also evident. Thus, the median pain severity according to the VAS during the examination using the standard method was 7 (Q1-Q3 7-8), compared to 3 (Q1-Q3 3-4) points, when a urethral speculum was used. The results of urinalysis demonstrated that erythrocyturia was detected in 43 patients (86%) at the end of the examination using tweezers. At the same time, after the examination using the original speculum, microhematuria was detected in 10 women (20%). Statistical analysis showed significant differences both in the pain severity scores according to the VAS (p<0.001) and in the presence of microhematuria at the end of the examination (2=31; p<0.001). Thus, the time of the examination was reduced by 51.6%, and the number of identified ducts increased by 1.75 times, which indicates the diagnostic efficiency of using a specialized urethral retractor. The proposed device allowed to reduce the pain of examination by 2.3 times, and also reliably (by 52%) decrease erythrocyturia, which confirms its greater safety.
CONCLUSION: The use of a urethral speculum is an innovative, effective, fast and atraumatic way to visualize the urethra in women with suspected skenitis.