Paraurethral cyst in female newborn – case report

Introduction: Paraurethral cyst, arise from the para(peri)urethral glands, that are homologous to the male prostate, and empty into the female urethra by their own ducts. There are 6 to30 ducts in the adult female and the largest 2 of these are referred to as Skene's duct. Although the etiology of this lesion is not fully understood, an inflammation of the gland, caused by obstruction of the duct, is an acceptable theory. It has been postulated that maternally acquired female hormones, which provoke glandular secretion, may also play a role in the pathogenesis. This theory is supported by the fact that almost all the cases are reported in full-term newborns. The incidence is believed to be around 1:1000–1:2000, but only about 50 cases have been previously reported in the literature (1). Many pediatric textbook do not mention or only make a brief comment of this rare entity. The diagnosis is made easily by physical examination. The differenzial diagnosis are other intralabial masses such as prolapsed ectopic ureterocele, prolapsed urethra, imperforated hymen and vaginal rhadomyosarcoma. The management of this lesion is controversial. Excision, marsupialization and needle aspiration are possible surgical alternatives, but many recommend a conservative approach, as natural resolution within a few months is the likely outcome (2). Case report: We report on a female infant who presented intralabial mass on the third day of life. The pregnancy was uneventful, and the child was delivered normally after 39+3 weeks of gestation. On a routine physical examination we found a 3×3cm yellow cystic mass on the right of the urethral meatus and superior to the vaginal introitus. The Hymen was normal and the vagina was patent. The vaginal introitus was minimally displaced. The rest of the physical examination was normal. Abdominal sonography revealed a normal urinary bladder and kidneys, and an infantile uterus and ovaries. A conservative management with closed observation was decided after discussion with the parents. The child returned to a follow-up examination after a week which revealed a clearly smaller mass, and complete resolution was seen after 6 weeks. Conclusion Paraurethral cyst is a am important rare differenzial diagnosis of the intralabial masses in the neonatal period. A correct diagnosis can save the child unnecessary surgical intervention, as most of the lesions resolve spontaneously.

Literature:

(1) Paraurethral cysts in newborn: a case report and review of literature. European journal of pediatric surgery; 10(1) 65–7 (02.2000)

(2) Paraurethral cyst in female newborn: Is surgery always advocated? Journal of pediatric surgery;42(2) 400–3 (02.2007)