Differential diagnosis

• Any abnormal urethral mucosa warrants biopsy/excision to r/o cancer
• Caruncle = mucosal prolapse (mucosa still smooth/normal), can bleed/be irritative
• Asymptomatic = education, reassurance
• Symptomatic/bothersome - sitz baths, estrogen cream
• Severe pain/necrosis - surgical excision
• Urethral diverticulum
• Etiology
• Can be congenital
• 2/2 infection of periurethral/Skene's glands (trauma/birth, surgery)
• Can be false (bulking agent seen on MRI)
• Classification
• Location, number, size
• Configurations - round, saddle-shaped/crescent, circumferential/'U'
• Only factor that impacts success; saddle shape is worse
• Site of communication
• Continence status
• True vs pseudo
• Pseudodiverticula = disruption of periurethral fascia via surgery; will not have ostia/neck of true tic
• True diverticula are contained deep to periurethral fascia
• Mass on physical exam in 80%
• Expressable purulence from urethra is diagnostic
• Symptoms - "3 D's"
• Dysuria - 40%
• Dyspareunia - 30%
• Dribble - 20%
• D+D+D = < 20%
• Expression of purulent fluid - 25%
• Diagnose with MRI - 97% sensitive, gives good anatomic information
• Mostly inflammation, can find malignancy in 3%
• Surgery = excise neck of diverticulum/close ostia and close periurethral fascia > removing entire sac
• Skene's duct (paraurethral) cyst
• Ducts terminate in mid/distal urethra at 3 and 9 o clock
• Mullerian cyst = midline
• 44% of all vaginal cysts
• Gartner's duct cyst = lateral wall of vagina (remnant in broad ligament)
• Rare
• Bartholin's gland cyst = 5, 7'oclock