Open Journal of Urology, 2011, 1, 48-49
doi:10.4236/oju.2011.13010 Published Online August 2011 (http://www.SciRP.org/journal/oju)
Paraurethral Cysts in a Female Newborn
Shruti Dhapodkar, Kaveh Homayoon
Departments o f Urology and Surgery, Maricopa Int egrated Health System s, Phoenix, USA
Received May 13, 201 1; revised July 5, 2011; accepted July 12, 2011
Abstract
Paraurethral cysts are a rare congenital abnormality seen in female neonates. We present the case of a female
newborn with a paraurethral cyst resulting in urinary obstruction. Surgical intervention was chosen as a re-
sult of the obstruction.
Keywords: Congenital External Genital Cyst, Paraurethral Cyst, Vaginal Cyst, Skene’s Gland, Urethra
1. Introduction
Congenital paraurethral cysts are rare in neonates. We
present a case of a neonate with paraurethral cyst.
2. Case Report
The patient was a one day old female with 41 week ges-
tational age, natural gestation and uneventful vaginal
delivery who was foun d to have a 0.5 × 1 cm protruding
mass in the vaginal vestibu le upon physical examination.
The mass was ovoid in shape and was yellow-orange in
color (Figure 1). The patient had urinar y obstruction and
it was suspected that the cyst was blocking the distal
meatus.
An ultrasound was ordered which revealed bilateral
fullness in the renal pelves. There was no evidence of
hydronephrosis, nephro lithiasis or perinephric fluid.
Due to the obstruction, surgical intervention was cho-
sen. A longitudinal incision was made over the protrud-
ing cyst, resulting in the exudation of a white milky liq-
uid. The entire cyst was excised and unroofed.
The pathology of the cyst showed benign squamous
inclusion cyst, consistent with the histology of a parau-
rethral cyst. The patient’s urinary symptoms resolved
and follow up visits showed no recurrence.
3. Discussion
Paraurethral glands, or Skene’s glands, first described by
Scottish gynecologist Alexander Skene in 1880 [1], are
the largest of the female urethral glands. The paraurethral
glands have 6 - 30 ducts which merge into two main
ducts draining into distal urethra [2]. Paraurethral glands
secrete a mucus-like substance that provides lubrication
to the urethral meatus, particularly in response to sexual
stimulation [3]. As such, the paraurethral glands are re-
garded as rudimentary analogues to the male prostate [2].
Paraurethral gland cysts are rare congenital abnormal-
ity which present as an interlabial cystic mass in new-
born girls. The true incidence of this anomaly is not
known. The reported incidence varies from 1 in 2074 to
1 in 7242 female births [4].
3.1. Diagnosis
Differential diagnoses for interlabial masses include
Gartner’s duct cysts, inclusion cysts of the vaginal wall,
urethral neoplasm, urethral prolapse, urethral diverticu-
lum, Mullerian remnant cyst, prolapsed ectopic uretero-
cele, hymenal cyst and vaginal neoplasm [5]. Usually
physical examination of external genitalia is diagnostic
but ultrasound can be used to facilitate in narrowing
down the differentials.
3.2. Etiology
The exact etiology of paraurethral cysts is not known.
Exposure to maternal estrogen has been reported as a
possible cause for development of paraurethral cyst but
there is no documented report of maternal exposure in
any of the reported cases in the English literature [6].
Indeed, no reports of paraurethral cysts have been found
in newborn girls born from mothers who were exposed to
Diethylstilbestrol (DES), which was used for prevention
of miscarriage between 1938 and 1971 [7,8]. In add ition,
many studies have shown an increased incidence of ma-
ternal exposure to environmental estrogens with subse-

S. DHAPODKAR ET AL.
49
Figure 1. Paraurethral cyst presenting as a 0.5 cm × 1 cm
protruding mass.
quent development of congenital anomalies in their in-
fants [9,10]. If maternal estrogen was a key player in the
development of paraurethral cysts, we would have ex-
pected to see an increase in the incidence of paraurethral
cysts. However, no such increase has been observed.
Another proposed cause for the cysts is the obstruction
of Skene’s gland ducts due to an improperly timed or
delayed open ing; stenosis of the duct; or obstr uction b y a
mucus plug [11,12].
A third theory postulates that a dislocation of the uro-
thelium from the urogenital sinus into the neighboring
area may underlie the etiology of the paraurethral cyst
[11,12].
3.3. Prognosis and Treatment Options
Many reports in the literature indicate spontaneous reso-
lution of paraurethral cysts within 76 to 304 days [7].
Therefore, many advocate the conservative (“watch and
wait”) method as the primary approach for the manage-
ment of congenital p araurethral cyst. It is not clear if this
spontaneous resolution is as a result of gradual opening
of the duct, perforation of the cyst or absorption of the
cyst content.
There are also reports in the literature indicating per-
sistence of the cyst requiring surgical drainage at a later
time [6]. Drainage of the cyst by aspiration, unroofing
and marsupialization have been tried with immediate
resolution of the cyst. All of these procedures are safe
and can be performed in a short period of time. Such an
approach will reduce the need for follow up and allevi-
ates the parents’ anxiety.
4. Conclusions
The incidence of paraurethral cysts may be higher than
reported. It is typically diagnosed upon physical exami-
nation, although ultrasound may be used to confirm. Du e
to many reported incidents of spontaneous resolution of
these cysts within 304 days, there is a precedent for
non-intervention. For persistent cysts or cases where
intervention is required, drainage of the cysts by aspira-
tion, unroofing and marsupialization have all been tried
with success.
5. References
[1] A. J. C. Skene, “The Anatomy and Pathology of Two
Important Glands of the Female Urethra,” American
Journal of Obstetrics & Gynecology, Vol. 13, 1880, pp.
265-270.
[2] S. L. Tepper, L. Jagirdar, D. Heath, et al., “Homology
between the Female Paraurethral (Skene’s) Glands and
the Prostate. Immunohistochemical Demonstration,” Ar-
chives of Pathology & Laboratory Medicine, Vol. 108,
1984, pp. 423-425.
[3] P. Merlob, C. Bahari, E. Liban, et al., “Cysts of the Fe-
male External Genitalia in the Newborn Infant,” Ameri-
can Journal of Obstetrics & Gynecology, Vol. 132, 1978,
pp. 607-610.
[4] T. Fujimoto, T. Suwa, N. Ishii, et al., “Paraurethral Cyst
in Female Newborn: Is Surgery Always Advocated?”
Journal of Pediatric Surgery, Vol. 42, No. 2, 2007, pp.
400-403. doi:10.1016/j.jpedsurg.2006.10.030
[5] A. R. Nussbaum and R. L. Lebowitz, “Interlabial Masses
in Little Girls: Review and Imaging Recommendations,”
American Journal of Roentgenology, Vol. 141, No. 1,
1983, pp. 65-71.
[6] J. E. Wright, “Paraurethral (Skene’s Duct) Cysts in the
Newborn Resolve Spontaneously,” Pediatric Surgery In-
ternational, Vol. 11, 1996, pp. 191-192.
doi:10.1007/BF00183766
[7] L. Titus-Ernstoff, R. Troisi, E. E. Hatch, et al., “Birth
Defects in the Sons and Daughters of Women Who Were
Exposed in Utero to Diethylstilbestrol (DES),” Interna-
tional Journal of Andrology, Vol. 33, No. 2, 2010, pp.
377-384. doi:10.1111/j.1365-2605.2009.01010.x
[8] R. Clark, “Estrogen & Breast Cancer Risk: Factors of
Exposure,” BCERF Environmental Risk Factor Database.
[9] R. R. Newbold, E. Padilla-Banks and W. N. Jefferson,
“Environmental Estrogens and Obesity,” Molecular &
Cellular Endocrinology, Vol. 304, No. 1-2, 2009, pp.
84-89. doi:10.1016/j.mce.2009.02.024
[10] J. G. Blaivas, V. M. Pais and A. B. Retik, “Paraurethral
Cysts in Female Ne onate,” Urology, Vol. 7, No. 5, 1976,
pp. 504-507. doi:10.1016/0090-4295(76)90191-6
[11] H. M. Kimbrough and E. D. Vaughan, “Skene’s Duct
Cyst in a Newborn: Case Report and Review of the Lit-
erature,” Journal of Urology, Vol. 117, 1977, pp. 387-
388.
[12] N. H. Lee and S. Y. Kim, “Skene’s Duct Cysts in Female
Newborns,” Journal of Pediatric Surgery, Vol. 27, No. 1,
1992, pp. 15-17. doi:10.1016/0022-3468(92)90094-N