Periurethral and Anterior Vaginal Wall Masses: Etiology, Presentation, and Treatment Outcomes
Authors: Jacox Natalie , Yao Henry Han-I , Baverstock Richard , Trpkov Kiril , Carlson Kevin 
Published: March 2023

ABSTRACT
Periurethral and anterior vaginal masses are relatively common with an estimated prevalence of 3% to 4% and 1%, respectively. These masses often cause diagnostic challenges due to nonspecific and overlapping symptoms. Urinary symptoms include frequency, urgency, and dysuria; vaginal discharge, urinary tract infection (UTI), dyspareunia, bleeding, postvoid dribbling, pelvic and urethral pain, and palpable mass can also present. Familiarity with differentiation of masses is important to make timely diagnoses and to expedite treatment without delays. This study aimed to describe the etiology of periurethral and anterior vaginal wall masses in a large series, as well as report the clinical presentations to determine whether the differential diagnosis can be narrowed based on presenting symptoms.
The study consisted of a retrospective chart review, based on charts of patients from November 2001 to July 2021 at a tertiary referral center. Analyzed data included age, body mass index, operative findings, operative time, concomitant procedures, pathologic diagnosis, catheterization time, complications, length of stay, symptoms on follow-up, and follow-up duration. Describing the etiology of periurethral and anterior vaginal wall masses was the primary objective of the study (including underlying etiology distribution), followed by the secondary objective of describing rates of other clinical characteristics. A systematic search of literature was performed using various databases: MEDLINE (Ovid), Cochran Central Register of Controlled Trials (Wiley Online Library), EMBASE (Elsevier), and Scopus.
The study included a total of 126 patients, all with at least 1 symptom exhibited. The most common presenting symptoms were palpable mass, dyspareunia, and urinary tract symptoms (dysuria, stress urinary incontinence [SUI], and UTI). There was an infection rate of 21.4% and a malignancy rate of 1.6%. Each patient underwent surgical treatment, including urethral repair, periurethral cyst excision, urethral diverticulectomy, and lesion excision. A total of 29.4% of patients reported SUI preoperatively. Postoperatively, 105 patients reported no incontinence (83.3%), 15 reported SUI (11.9%), 5 reported mixed urinary incontinence (4%), and 1 presented with overflow incontinence (0.8%).
Limitations of the study include the prospective collection of data but its retrospective analysis, thereby limiting findings according to the accuracy and completeness of the medical records. In addition, there was an absence of patient-reported outcome measures when SUI or other symptoms were assessed, and the authors recognize a need for future prospective studies to include such outcome measures.
This large series evaluation of periurethral and anterior vaginal wall masses is the largest of its kind, as the previous study included only 79 patients with periurethral masses, 96% of whom had definitive pathological diagnoses and surgical treatment. This study provides a broad view into the etiological spectrum underlying periurethral and anterior vaginal masses. Malignancy is rare. Infectious pathology is common and found in 21.4% of patients, whereas urethral diverticulum was the most common pathology (40% of cases). Finally, this study indicated high success rates for surgical excisions, as there were no recurrences among diverticula patients in the study. For Skene’s gland cyst excisions, a recurrence rate of less than 1% was noted.