Abstract
Giriş: Önceden sistosel olarak bilinen ön vajinal duvar prolapsusu (AVWP), ön vajinal duvar ve mesanenin herniasyonudur. Çok faktörlü bir patolojidir. AVWP'li hastalar, spesifik olmayan semptomlar olan pelvik baskı hissi ve vajinadan dışarı taşan bir şey, idrar kaçırma ve disparoni bildirebilir.
Olgu: Türk, 73 yaşında, evli, 20 yıldır menopozda olan G4P4 kadın hasta, iki haftadır dizüri ve idrar kaçırma ve 2 yıldır genital bölgede ele gelen kitle şikayeti ile polikliniğimize başvurdu. Vajinal muayenesinde vajen ve serviks normal görünüyordu ve sistosel poşunun altında distal üretradan mesane tabanına uzanan semimobil kitle ile birlikte grade 3 AVWP görüldü. Cerrahi eksizyon planı ile 3. derece AVWP teşhisi kondu. Üretra altında mesane duvarına kadar uzanan 4-5 cm boyutlarında bilobüler kistik kitle izlendi. Makroskopik incelemede 4,5 x 2,8 x 2 cm boyutlarında zaröz doku parçası, mikroskobik incelemede kazeifiye granülomatöz enflamasyon saptandı. Tüberküloz şüphesi ile enfeksiyon hastalıkları (ID) polikliniğine sevk edildi. PPD testi 0 mm idi. Aktif tüberküloz şikayeti yoktu. İdrar kaçırma şikayeti ile kliniğimize başvurdu. Vajinal muayenesinde mesane uyarımı ile istemsiz idrar kaçırdığı görüldü. Transvajinal bant (TVT) implantasyonunu planlandı.
Tartışma: Bu vakanın AVWP'nin ayırıcı tanısı hakkında fikir oluşturmasına yardımcı olacağını düşünüyoruz. Yanlış tanıya yol açmamak için AVWP tanısından emin olunmadan önce ön vajinal duvarın mesane ve üretraya yakınlığı nedeniyle olası diğer genitoüriner patolojiler ayırıcı tanıda yer almalıdır.
References
- UpToDate. Pelvic organ prolapse in females: Epidemiology, risk factors, clinical manifestations, and management. Accessed August 9, 2022. https://www.uptodate.com/contents/pelvic-organ-prolapse-in-females-epidemiology-risk-factors-clinical-manifestations-and-management
- National Library of Medicine. Pelvic Organ Prolapse. Accessed July 20, 2022. https://www.ncbi.nlm.nih.gov/books/NBK563229/
- Jadhav J, Koukoura O, Joarder R, Edmonds S. Urethral diverticulum mimicking anterior vaginal wall prolapse: case report. J Minim Invasive Gynecol 2010;17(3):390-2. doi: 10.1016/j.jmig.2010.01.010
- Greenwell TJ, Spilotros M. Urethral diverticula in women. Nat Rev Urol 2015;12(12):671-80. doi: 10.1038/nrurol.2015.230
- Touimi Benjelloun A, Ziad I, Elkaroini D, Boufettal H, Mahdaoui S, Samouh N. Vaginal leiomyoma mimicking a Cystocele (report case). Int J Surg Case Rep 2022;93:106955. doi: 10.1016/j.ijscr.2022.106955
- Lee SW, Kim MS, Hwang HJ , Chung YH, Lee SJ. Urethral diverticulum misdiagnosed with cystocele. Journal of Obstetrics and Gynaecology 2014;34:5,450. doi: 10.3109/01443615.2014.899331
- Töz E, Sancı M, Cumurcu S, Özcan A. Müllerian cyst of the vagina masquerading as a cystocele. Case Rep Obstet Gynecol 2015;2015:376834. doi: 10.1155/2015/376834
- Sharifiaghdas F, Mahmoudnejad N, Mohseni M. Huge vaginal wall Mullerian cyst mimicking high stage pelvic organ prolapse. Uro J 2021 Jul 12. doi: 10.22037/uj.v18i.6872
- Nohuz E, Albaut M, Bayeh S, Champel N, Khenifar E. A Gartner's duct cyst mimicking a cystocele. Prog Urol 2016;26(16):1150-1152. doi: 10.1016/j.purol.2016.10.002
- Ayari Y, Kerkeni W, Znaidi N, Blel A, Bouzouita A, Ayed H, et al. Clear Cell Adenocarcinoma of the Female Urethra, Mimicking Cystocele. Urol Case Rep 2017;12:26-27. doi: 10.1016/j.eucr.2017.02.005
- Long CY, Wang CL, Hsu CS. Anterior vaginal cyst mimicking a cystocele assessed by transperineal ultrasound. Eur J Obstet Gynecol Reprod Biol 2012;165(1):128-9. https://doi.org/10.1016/j.ejogrb.2012.06.032
- Esber A, Radosa M, Wickel J, Mothes H, Runnebaum IB, Mothes A. Vaginal cysts: An important differential diagnosis in the anterior compartment. Eur J Obstet Gynecol Reprod Biol 2021;267, 280–284. https://doi.org/10.1016/j.ejogrb.2021.11.422
- Huang WC, Yang SH, Yang SY, Yang E, Yang JM. Vaginal abscess mimicking a cystocele and causing voiding dysfunction after Burch colposuspension. J Ultrasound Med 2009;28(1):63-6. doi: 10.7863/jum.2009.28.1.63
- Benlghazi A, Belouad M, Bouhtouri Y, Benali S, El Hassani MM, Kouach J. Anterior vaginal cyst mimicking pelvic organ prolapse: Case report and literature review. Int J Surg Case Rep. 2023 Sep 30;111:108868. doi: 10.1016/j.ijscr.2023.108868
- Romero Reyes R, Rodríguez Colorado S, Escobar del Barco L, Gorbea Chávez V. Suburethral cyst. A case report. Ginecol Obstet Mex 2009;77(3):160-4. Spanish. PMID: 19400521
- Romero RR, Rodríguez CS, Escobar BL, Gorbea CV. Quiste suburetral. Reporte de un caso. Ginecol Obstet Mex 2009;77(3 ):160-4
- Ceylan H, Ozokutan BH, Karakom M, Buyukbese S. Paraurethral cyst: is conservative management always appropriate? Eur J Pediatr Surg 2002;12(3):212-4
Abstract
Introduction: Anterior vaginal wall prolapse (AVWP), previously known as cystocele, is a herniation of the anterior vaginal wall and the bladder. It is a multifactorial pathology. Patients with AVWP may report a feeling of pelvic pressure and something bulging out of the vagina, urinary incontinence, and dyspareunia which are nonspecific symptoms.
Case: A 73-year-old married Turkish G4P4 female who has been menopausal for 20 years, presented to the outpatient clinic with dysuria and urinary incontinence lasting for two weeks, and a palpable mass located in the genital area for 2 years. On her vaginal examination, the vagina and cervix appeared normal, and a grade 3 AVWP along with a semi-mobile mass extending from the distal urethra to the bladder base under the cystocele pouch was observed. She was diagnosed with a grade 3 AVWP with a plan for the surgical excision. A bilobular cystic mass was observed under the urethra, extending to the bladder wall with a size of 4-5 cm. The macroscopic examination showed a membraneous tissue piece of 4.5 x 2.8 x 2 cm, and the microscopic examination revealed a caseified granulomatous inflammation. Upon the suspicion of tuberculosis, we referred her to the infectious diseases (ID) clinic. Her PPD test was 0 mm. She had no complaints of active tuberculosis. She presented to our clinic with urinary incontinence. On her vaginal examination, involuntary leakage of urine with bladder stimulation was observed. We planned the implantation of transvaginal tape (TVT).
Discussion: We believe that this case will help establish an idea about the differential diagnosis of AVWP. The differential diagnosis should include the other possible genitourinary pathologies due to the close proximity of the anterior vaginal wall to the bladder and the urethra before ensuring the diagnosis of the AVWP in order not to misdiagnose.
References
- UpToDate. Pelvic organ prolapse in females: Epidemiology, risk factors, clinical manifestations, and management. Accessed August 9, 2022. https://www.uptodate.com/contents/pelvic-organ-prolapse-in-females-epidemiology-risk-factors-clinical-manifestations-and-management
- National Library of Medicine. Pelvic Organ Prolapse. Accessed July 20, 2022. https://www.ncbi.nlm.nih.gov/books/NBK563229/
- Jadhav J, Koukoura O, Joarder R, Edmonds S. Urethral diverticulum mimicking anterior vaginal wall prolapse: case report. J Minim Invasive Gynecol 2010;17(3):390-2. doi: 10.1016/j.jmig.2010.01.010
- Greenwell TJ, Spilotros M. Urethral diverticula in women. Nat Rev Urol 2015;12(12):671-80. doi: 10.1038/nrurol.2015.230
- Touimi Benjelloun A, Ziad I, Elkaroini D, Boufettal H, Mahdaoui S, Samouh N. Vaginal leiomyoma mimicking a Cystocele (report case). Int J Surg Case Rep 2022;93:106955. doi: 10.1016/j.ijscr.2022.106955
- Lee SW, Kim MS, Hwang HJ , Chung YH, Lee SJ. Urethral diverticulum misdiagnosed with cystocele. Journal of Obstetrics and Gynaecology 2014;34:5,450. doi: 10.3109/01443615.2014.899331
- Töz E, Sancı M, Cumurcu S, Özcan A. Müllerian cyst of the vagina masquerading as a cystocele. Case Rep Obstet Gynecol 2015;2015:376834. doi: 10.1155/2015/376834
- Sharifiaghdas F, Mahmoudnejad N, Mohseni M. Huge vaginal wall Mullerian cyst mimicking high stage pelvic organ prolapse. Uro J 2021 Jul 12. doi: 10.22037/uj.v18i.6872
- Nohuz E, Albaut M, Bayeh S, Champel N, Khenifar E. A Gartner's duct cyst mimicking a cystocele. Prog Urol 2016;26(16):1150-1152. doi: 10.1016/j.purol.2016.10.002
- Ayari Y, Kerkeni W, Znaidi N, Blel A, Bouzouita A, Ayed H, et al. Clear Cell Adenocarcinoma of the Female Urethra, Mimicking Cystocele. Urol Case Rep 2017;12:26-27. doi: 10.1016/j.eucr.2017.02.005
- Long CY, Wang CL, Hsu CS. Anterior vaginal cyst mimicking a cystocele assessed by transperineal ultrasound. Eur J Obstet Gynecol Reprod Biol 2012;165(1):128-9. https://doi.org/10.1016/j.ejogrb.2012.06.032
- Esber A, Radosa M, Wickel J, Mothes H, Runnebaum IB, Mothes A. Vaginal cysts: An important differential diagnosis in the anterior compartment. Eur J Obstet Gynecol Reprod Biol 2021;267, 280–284. https://doi.org/10.1016/j.ejogrb.2021.11.422
- Huang WC, Yang SH, Yang SY, Yang E, Yang JM. Vaginal abscess mimicking a cystocele and causing voiding dysfunction after Burch colposuspension. J Ultrasound Med 2009;28(1):63-6. doi: 10.7863/jum.2009.28.1.63
- Benlghazi A, Belouad M, Bouhtouri Y, Benali S, El Hassani MM, Kouach J. Anterior vaginal cyst mimicking pelvic organ prolapse: Case report and literature review. Int J Surg Case Rep. 2023 Sep 30;111:108868. doi: 10.1016/j.ijscr.2023.108868
- Romero Reyes R, Rodríguez Colorado S, Escobar del Barco L, Gorbea Chávez V. Suburethral cyst. A case report. Ginecol Obstet Mex 2009;77(3):160-4. Spanish. PMID: 19400521
- Romero RR, Rodríguez CS, Escobar BL, Gorbea CV. Quiste suburetral. Reporte de un caso. Ginecol Obstet Mex 2009;77(3 ):160-4
- Ceylan H, Ozokutan BH, Karakom M, Buyukbese S. Paraurethral cyst: is conservative management always appropriate? Eur J Pediatr Surg 2002;12(3):212-4
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Case Report |
| Authors | |
| Early Pub Date | December 29, 2023 |
| Publication Date | December 31, 2023 |
| Submission Date | June 11, 2023 |
| Published in Issue | Year 2023 Volume: 33 Issue: 6 |
Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).