Skene Gland Excision with Concomitant Retropubic Midurethral Sling Placement

Objectives: Skene’s glands, located inferiorly and laterally on either side of the urethra, are paraurethral glands that arise from the urogenital sinus. Skene gland cysts form when the gland is obstructed, often caused by bacterial infection. The most common symptoms include urinary frequency, urgency, dysuria, voiding dysfunction, palpable mass, and urinary tract infections. Surgical management of concomitant stress urinary incontinence (SUI) at the time of Skene’s gland cyst excision presents a challenge to surgeons, as injury to the periurethral fascia precludes synthetic sling placement. The objective of this video is to describe our technique of surgical management Skene’s gland cyst excision with concomitant midurethral sling placement, while providing surgical tips to ensure success.

Methods: We present the case of a 40-year-old patient who presented with complaints of vaginal bulge and urinary leakage with physical activity. MRI and urodynamics (UDS) were performed preoperatively, confirming the diagnosis of Skene’s gland cyst with no communication between the cyst and urethra, and SUI demonstrated on UDS. The technique of surgical excision of the Skene gland cyst is presented in the accompanying video, and includes dissection of cyst wall from the urethra, cystourethroscopy, transurethral methylene blue dye injection to ensure periurethral fascia is not breached, complete removal of cyst wall, primary vaginal-wall closure, and retropubic midurethral sling dissection and placement.

Clinical Relevance: There is currently no standardized approach to concomitant surgical management of Skene’s gland cysts and SUI. In this scenario, most surgeons elect fascial sling over retropubic midurethral sling. We present a case of retropubic midurethral sling placement at the time of Skene gland excision, along with surgical tips for success. Midurethral sling placement at the time of Skene gland excision should be based on the location of the Skene gland dissection, ensuring it is separate from the path of the sling dissection and placement and preoperative evaluation that confidently rules out urethral diverticulum.