Rapidly Expanding Anterior Vaginal Wall Mass Requiring Emergent Surgery

INTRODUCTION: Skene’s glands are paraurethral glands, which drain inconspicuously in most women. However, if the gland becomes obstructed, it can form an anterior vaginal wall cyst and, in rare occasions, form an abscess. The treatment of a Skene’s gland abscess includes cyst removal, partial cyst removal with marsupialization, and incision and drainage. There is no clear consensus on the standard management, especially in this setting. OBJECTIVE: This video reviews the technique of Skene’s gland marsupialization in the setting of an abscess. METHODS: A 28-year-old presented to the hospital for evaluation of a nonpainful anterior vaginal mass. The plan at that time was for outpatient imaging. The patient represented one day later with worsening symptoms. On exam, she had a tender, fluctuant mass involving the distal sub-urethral tissue, deviating the urethral meatus. Her white blood cell count rose significantly. She was initiated on intravenous antibiotics and consented for surgical management. A cruciate incision was made in the vaginal epithelium overlying the most tense, dependent portion of the cyst. Four epithelial flaps were developed, and the tissue was undermined taking care not to rupture the cyst. Marsupialization was accomplished with 3-0 monocryl interrupted stitches, with one interrupted placed at each quadrant to ensure adequate marsupialization and eversion of the cyst wall to the epithelial flaps. RESULTS: Pathology was consistent with an infected Skene’s gland cyst. Culture revealed E. coli. The patient was discharged home on postoperative day one with a Foley catheter. She was initiated on a seven-day course of doxycycline. She passed an active voiding trial on postoperative day five. She had no postoperative complications. CONCLUSIONS: There is no consensus for the management of Skene’s gland abscesses currently. Marsupialization is a surgical technique that can be used for emergent cases.