Suburethral masses in women are relatively uncommon but can arise from various causes. They are typically located beneath the urethra in the anterior vaginal wall and can present with symptoms like urinary obstruction, incontinence, or dyspareunia, or may be asymptomatic and found incidentally. Below are the common causes and considerations:
Causes of Suburethral Masses
1. Urethral Diverticulum
• Ethiology: Congenital or acquired (e.g., due to chronic infection or trauma).
• Presentation:
- Dysuria, post-void dribbling, dyspareunia, recurrent UTIs (“3 Ds” symptoms).
- A soft, fluctuant mass may be palpable on vaginal examination.
• Diagnosis: MRI, ultrasound, or voiding cystourethrogram (VCUG).
• Management: Surgical excision.
2. Skene’s Gland Cysts/Abscesses
• Ethilogy: Blockage of Skene’s ducts, potentially
secondary to infection.
• Presentation:
- Tender, fluctuant suburethral mass.
- May cause pain, dyspareunia, or dysuria.
• Management: Incision and drainage, with possible
antibiotics if infected.
3. Urethral Caruncle
• Ethilogy: Benign polypoid lesion at the urethral meatus, commonly in postmenopausal women due to estrogen deficiency.
• Presentation:
- Small, red, friable mass at the urethral opening.
- May bleed or cause irritation.
• Management: Observation, topical estrogen, or excision if symptomatic.
4. Urethral Prolapse
• Ethilogy: Circular eversion of the urethral mucosa, often in prepubertal girls or postmenopausal women.
• Presentation:
- Circumferential suburethral swelling.
- Can mimic a mass.
• Management: Topical estrogen, sitz baths, or surgical correction.
5. Benign Tumors
• Examples: Leiomyomas, fibromas, or lipomas.
• Presentation: Non-tender, well-circumscribed suburethral masses.
• Management: Surgical excision for symptomatic relief or diagnosis.
6. Malignancy
• Examples: Urethral carcinoma, rare suburethral metastases (e.g., bladder or vaginal cancer).
• Presentation: Firm, irregular mass with possible ulceration or bleeding.
• Management: Depends on histopathological diagnosis (e.g., surgery, chemotherapy, or radiotherapy).
7. Ectopic Ureters
• Etiology: Congenital anomaly where the ureter opens ectopically into the vaginal wall.
• Presentation: Continuous urinary dribbling from birth or early life.
• Diagnosis: Imaging (e.g., renal ultrasound or MRI).
• Management: Surgical correction.
Evaluation of Suburethral Masses
1. History:
• Symptoms: Dysuria, post-void dribbling, pain, bleeding, incontinence, or recurrent UTIs.
• Onset, duration, and aggravating/relieving factors.
2. Physical Examination:
• Inspect and palpate the anterior vaginal wall.
• Check for tenderness, size, consistency, and reducibility.
3. Imaging/Diagnostics:
• Pelvic Ultrasound: Initial investigation.
• MRI: Superior for soft tissue characterization.
• Cystourethroscopy: Direct visualization of the urethral lumen.
• VCUG: Useful for urethral diverticula.
4. Biopsy: Indicated for suspicious or recurrent masses to rule out malignancy.
Management Overview
• Symptomatic or enlarging masses often require surgical evaluation.
•. For asymptomatic benign lesions, conservative management or observation may suffice.
•. Always consider underlying infection or malignancy when evaluating these masses.
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