title: Periurethral masses: etiology and diagnosis in a large series of women.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Joan and Sanford Weill College of Medicine, Cornell University, New York, New York 10021, USA. JBLVS@aol.com
authors.forename: Jerry G
authors.initials: JG
authors.lastname: Blaivas
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Flisser
authors.forename: Clifford B
authors.initials: CB
authors.lastname: Bleustein
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D014522:Urethral Diseases / Q000175:diagnosis* / Q000209:etiology*