Definition:
It consists of the removal of cystic retention formation, of benign nature by definition, which can derive from the vaginal wall, mesonephric embryonic residues (Gartner cysts), urethral glands or paraurethral glands (Skene’s: in number two, they have the excretion duct on the side of the external urethral meatus in which also the urethral glands are drained, positioned relative to them more closely in relation to the urethra).
Clinically it manifests itself as a salience of the vaginal wall; It is often asymptomatic.
Indications:
It should be treated only if symptomatic, but in fact the therapy is poorly coded: some advocate non-treatment if it is asymptomatic, others (Blaivas, for example) propose exeresis anyway, to avoid the risk of their spontaneous rupture. However, it is important to exclude the dependence from the urinary system (differential diagnosis with urethral ectopia and urethral diverticulum is essential).
Technical Description:
The removal is performed by incision of the front wall of the vagina and enucleation of the cysts from the paraurethral tissues; It is usually accompanied by the presence of a urethra catheter to be able to temporarily repair the latter in case of accidental injury. After an accurate haemostasis, the vaginal front wall is sutured: a bunghole can be left for 24 to 48 hours in the vaginal lumen to allow a hemostasis for compression if necessary. The bladder catheter is normally left in place for a few hours, except in the case it’s needed to grant a continuity of the urethral wall.
Preparation:
Antibiotic prophylaxis and, for risky patients, antithrombotic prophylaxis is advised.
Duration of the procedure:
The entire procedure does not normally take more than 25-30 minutes.
Type of anesthesia:
Generally peripheral; For particular situations a local anesthesia may suffice.
Results:
The intervention should be considered definitively resolutive.
Complications:
Hemorrhage is usually contained and easily dominated by the simple compression produced by a swab in the vagina; Urethro-vaginal fistula may occur in cases of ischemic lesion of the urethral wall (the clinical manifestation will be apparent at a later date) or iatrogenic lesion of the latter, which is not recognized during the surgery and therefore not readily remedied.
Hospital stay:
It is an intervention that can also be performed in Day-Surgery (outpatient).
At discharge:
Avoid sexual intercourse until complete integrity of the front vaginal wall, accurate local hygiene with mild disinfectants.
What to do in case of complications:
Contact the urologist for what may be necessary.
Checks:
The first outpatient check will be performed after 7 days; The next one will be decided based on the objectivity found and essentially for the purpose of excluding complications.