Gartner Duct Cyst

A Gartner duct cyst is a cyst of the vaginal wall formed from a persistent remnant of the mesonephric (Wolffian) duct. It lies along the anterolateral wall of the vagina.

• It is usually single, 1 to 5 cm and thin-walled, lined by cuboidal epithelium.
• It is linked to urinary tract anomalies, including ipsilateral renal agenesis, ectopic ureter and Herlyn-Werner-Wunderlich syndrome (uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis).
• Women with a Gartner cyst need imaging of the kidneys and uterus.

Often asymptomatic and found at examination or in pregnancy.

• Vaginal swelling or fullness, dyspareunia, difficulty inserting tampons, urinary frequency or retention.
• In girls with an obstructed hemivagina: progressive pelvic pain and a pelvic mass after menarche, with normal menstruation from the other side.
• Differential diagnosis: Müllerian cyst, cystocele, urethral diverticulum, Skene cyst, Bartholin cyst, vaginal inclusion cyst, ectopic ureterocele, vaginal tumour.
• Complications: infection, urinary obstruction, dyspareunia, obstruction of labour, recurrence, and injury to an ectopic ureter during surgery.

Diagnosis is by examination, with imaging of the kidneys and uterus for associated anomalies.

• Speculum and bimanual examination.
• Renal tract ultrasound to look for absent kidney or hydronephrosis.
• Pelvic MRI, where available, to map the cyst, uterus, urethra and ureter.
• Ultrasound of the uterus for duplication and haematocolpos in adolescents.
• Cyst wall histology after excision.

Observe asymptomatic cysts and excise symptomatic ones after imaging of the urinary tract.

• Supportive: reassure that asymptomatic cysts are benign; warm sitz baths 10 to 15 minutes, 3 times daily; avoid tampons if painful.
• Pharmacological: paracetamol 1 g oral 6-hourly (maximum 4 g in 24 hours); child 15 mg/kg 6-hourly (maximum 60 mg/kg in 24 hours, maximum 1 g per dose). Infected cyst: amoxicillin-clavulanate 625 mg oral 8-hourly for 5 to 7 days (child 15 mg/kg of amoxicillin component 8-hourly, maximum 500 mg per dose).
• Procedures: observe asymptomatic cysts. Symptomatic cysts: complete excision or marsupialisation by an experienced surgeon, after MRI or imaging of the urinary tract. Place a ureteric stent before excision when an ectopic ureter is suspected. Avoid simple aspiration alone because of rapid recurrence. Drain an obstructed hemivagina by vaginal septum resection.
• Special groups: in pregnancy observe small cysts; a large cyst that blocks the birth canal needs caesarean delivery. In adolescents with obstructed hemivagina do not delay drainage.
• Red flags: progressive cyclical pelvic pain after menarche, pelvic mass, haematocolpos, urinary retention, fever.
• Follow-up: review at 2 weeks after surgery and at 3 months; renal follow-up when anomalies are found.