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Periurethral Masses: Etiology and Diagnosis in a Large Series of Women

Jerry G. Blaivas, MD^*, Adam J. Flisser, MD, Clifford B. Bleustein, MD and Georgia Panagopoulos, PhD

From the *Joan and Sanford Weill College of Medicine, Cornell University, New York; Lenox Hill Hospital, New York; Division of Urogynecology, Mount Sinai Medical Center, New York; and Department of Urology, Montefiore Medical Center, Bronx, New York.

Address reprint requests to: Jerry G. Blaivas, MD, 445 East 77th Street, New York, NY 10021; e-mail: JBLVS{at}aol.com.

OBJECTIVE: To describe the differential diagnosis of periurethral masses in a consecutive series extracted from a single tertiary urogynecologic practice database.

METHODS: A patient database of a private urology and urogynecology practice with 1,950 women was searched for patients who were found to have a periurethral mass during the accrual dates of 1994 to 2002, and these records were reviewed for diagnostic testing and results. All women provided a history, completed a questionnaire, and underwent physical examination, voiding diary, cystoscopy, and videourodynamic testing; selected patients then underwent additional imaging.

RESULTS: Seventy-nine (4%) patients aged 41.2 ± 14 years were identified. Of these, 72 (91%) had been referred for evaluation of persistent irritative lower urinary tract symptoms or incontinence. Seven patients (9%) had been referred specifically because of a periurethral mass. Sixty-six patients (84%; 95% confidence interval [CI] 73%, 91%) had urethral diverticula, of which 4 (6%; 95% CI 2%, 14.8%) contained malignancies. Six patients (7%; 95% CI 3%, 15%) had vaginal cysts histologically identified as fibromuscular tissue, 4 (5%; 95% CI 1%, 12%) had leiomyomata, and 2 (2.5%; 95% CI 0.03%, 8.8%) had ectopic ureteroceles. Two patients had vaginal squamous cell carcinomas (2.5%; 95% CI 0.03%, 8.8%), and 1 had an infected granuloma. Masses were palpable in 42 patients (53.8%; 95% CI 42%, 64%) and in 37 patients either were encountered at surgery (n = 5) or were urethral diverticula diagnosed by voiding cystourethrogram (n = 32).

CONCLUSION: Periurethral masses were encountered in less than 4% of our patient sample. Most masses were urethral diverticula; however, the differential diagnosis included leiomyoma, vaginal cysts, and malignancy. Masses were generally either palpable or seen at imaging studies performed during evaluation of lower urinary tract symptoms.

LEVEL OF EVIDENCE: iii

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