Anterior Vaginal Masses: A Review of Surgical Technique

Objectives: We present a video reviewing the techniques used in surgical management of anterior vaginal masses, specifically highlighting key steps in urethral diverticulectomy and paramesonephric duct cystectomy. We also include key physical examination findings to help differentiate between urethral diverticuli and vaginal cysts.

Methods: Anterior vaginal masses are common conditions seen in gynecology, with patients often complaining of symptoms such as dysuria, dyspareunia, urinary frequency and urgency, as well as the sensation of a vaginal mass. In this video, we review our approaches to urethral diverticulectomy and paramesonephric duct cystectomy. In urethral diverticulectomy, we start with inserting a Foley catheter to help prevent urethral injury during the procedure. We use a lateral approach to avoid injuring the urethra and sharply dissect the mass down to the stalk of the diverticular sac, confirming the communication between the sac and the urethra before excising the sac. After repair of the urethral defect, we assess watertightness of the repair using a 3-way catheter and injection of dye. Paramesonephric duct cystectomy is approached similarly to urethral diverticulectomy, with the initial incision determined by either the lateral or midline presentation of the mass. At the end of all repairs, we use cystourethroscopy to confirm no injury to the urethra, trigone or bladder. Postoperatively, a catheter is left in place for several days to allow the repair to heal.

Clinical Relevance: In our video, we point out key physical examination findings to differentiate between urethral diverticuli and vaginal cysts, which is important when counseling patients and planning surgical management. We also showcase our approach to urethral diverticulectomy and paramesonephric duct cystectomy, highlighting key techniques for successful surgical repair.