Abstract
Periurethral masses are uncommon in adult women, with little guidance on initial management. We describe a case of a 29-year-old pregnant woman with a single-system ureterocele prolapse complicated by multiple calculi ranging from 1 to 2.5 cm.
Periurethral masses are an uncommon entity, with an estimated prevalence of 3%–4% in adult women.1 There are no well-defined protocols to guide initial management because of the limited case series.2 In 2008, Waihenya3 reported the first case of a single-system ureterocele with prolapse.
A 29-year-old G2P1 woman who was 25 weeks pregnant was referred to us for a bleeding mass at her introitus, incontinence, and vaginal pain intermittently present for 4 months (Fig. 1). Her previous pregnancy was complicated by nephrolithiasis and a multidrug resistant urinary tract infection. On physical examination, a tender, firm, 4-cm hemorrhagic mass was located at the 6-o’clock position of the urethral meatus. Renal ultrasound showed moderate hydronephrosis of her right kidney, multiple renal calculi, and a single collecting system (Fig. 2). Examination under anesthesia and cystourethroscopy demonstrated significant inflammation at the trigone. The right ureteral orifice was unable to be identified. A diagnosis of a prolapsed ureterocele was made. The ureterocele was incised laterally (to avoid injuring the ureteral orifice), and it contained a 2.5-cm stone with smaller fragments (Fig. 3). After evacuation of the stones, the ureterocele was reduced into the bladder, and its anatomic location and decompression were confirmed with cystoscopy.
Figure 1.
Four-centimeter bleeding mass at the introitus.
Figure 2.
Renal ultrasound showing moderate hydronephrosis and a single collecting system in the right kidney.
Figure 3.
Surgical excision of the prolapsed ureterocele producing a 2.5-cm stone.
APPENDIX. Supplementary Data
Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j.urology.2013.11.021.
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
References
- 1.Pradhan S, Tobon H. Vaginal cysts: a clinicopathological study of 41 cases. Int J Gynecol Pathol. 1986;5:35–46. [PubMed] [Google Scholar]
- 2.Fletcher S, Lemack G. Benign masses of the female periurethral tissues and anterior vaginal wall. Curr Urol Rep. 2008;9:389–396. doi: 10.1007/s11934-008-0067-3. [DOI] [PubMed] [Google Scholar]
- 3.Waihenya C. Prolapsed single system ureterocele in a female adult: case report. East Afr Med J. 2008;85:197–200. doi: 10.4314/eamj.v85i4.9644. [DOI] [PubMed] [Google Scholar]