Skene Gland Cyst

A Skene gland cyst is a cystic dilatation of a paraurethral (Skene) gland caused by blockage of its duct, found beside the external urethral meatus.

• It occurs in newborn girls from maternal hormone stimulation and in adult women after infection or trauma.
• Most are small and asymptomatic.
• Large cysts obstruct the urethral stream.

Small, smooth, yellow-white or translucent cyst lateral or inferior to the urethral meatus, 0.5 to 3 cm.

• Newborns: asymptomatic swelling near the meatus, which may displace the urine stream.
• Adults: dysuria, dyspareunia, weak or deflected urinary stream, urinary retention, and recurrent urinary tract infection.
• Differential diagnosis: urethral diverticulum, urethral prolapse, ectopic ureterocele, Bartholin cyst, Gartner duct cyst, urethral caruncle, vulval carcinoma, paraurethral abscess.
• Complications: infection, abscess, urinary obstruction, recurrence, dyspareunia.

Diagnosis is clinical, with imaging to separate the cyst from a urethral diverticulum.

• Clinical diagnosis by inspection and palpation of the urethral meatus.
• Urine dipstick and culture.
• Pelvic ultrasound, or MRI where available, to separate the cyst from a urethral diverticulum.
• Endocervical or urethral swab for gonorrhoea and chlamydia.
• Biopsy of any solid, ulcerated or growing lesion.

Observe small cysts, and drain or excise those that are symptomatic, infected or obstructing the urine stream.

• Supportive: reassure parents that a newborn cyst resolves without treatment in weeks to months; warm sitz baths 10 to 15 minutes, 3 times daily; avoid irritants; hydration.
• Pharmacological: asymptomatic cyst needs no drug. For pain give 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). Urinary tract infection: nitrofurantoin modified-release 100 mg oral 12-hourly for 5 days (adults). 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). For gonorrhoea or chlamydia give ceftriaxone 500 mg IM single dose plus doxycycline 100 mg oral 12-hourly for 7 days.
• Procedures: newborn cyst: observation; if it obstructs urine flow or persists beyond 3 months, needle aspiration or marsupialisation under sedation. Adult symptomatic cyst: marsupialisation or excision under local or regional anaesthesia (1 percent lignocaine, maximum 3 mg/kg, absolute maximum 200 mg plain), taking care not to injure the urethra. Place a urethral catheter for 24 to 48 hours after surgery.
• Special groups: in pregnancy avoid doxycycline and give azithromycin 1 g oral single dose for chlamydia; defer elective surgery until after delivery.
• Red flags: urinary retention, fever, rapid enlargement, fixed mass, haematuria.
• Follow-up: review at 2 weeks and 3 months; examine for recurrence; refer for urethral diverticulum work-up if symptoms persist.