Skene's glands abscess an overlooked diagnosis in acute lower urinary symptoms

Abstract

Skenitis refers to the infection of the Skene's glands. Skene's glands are paraurethral glands localized on the upper wall of the vagina. The diagnosis of Skene's glands abscess or infection is usually made based on the history and physical examination, but half of women with para-urethral gland symptoms present with non-palpable lesions and necessitate further evaluation with imaging. Patients may present with chronic urethral pain, recurrent urinary tract infections, unexplained dyspareunia, and dysuria. At imaging Skene's glands are typically located on the anterior vaginal wall, at symphysis level and paramedian to urethra. Clinicians should consider Skenitis in the differential diagnosis of lower urinary tract symptoms. We report a case of a 48-year-old woman with acute lower urinary tract symptoms with a final diagnosis of Skene's glands abscess.

Keywords: Lower urinary tract symptoms; MRI; Magnetic Resonance Imaging; Paraurethral abscess; Skene's glands abscess; Skenitis; ULTRASOUND; US; paraurethral glands.

Fig. 1 (A-D)

Transabdominal ultrasound (A-D) A. Mildly dilated calico-pelvic system of the left kidney (white asterix). (B) Catheterized bladder (c). Below the bladder (b) an inhomogeneous fluid filled mass was appreciable (white arrow). (C) The fluid filled mass content was slightly inhomogeneous, the mass was septate (white arrowhead) with thick wall and localized below the bladder (maximum diameter 6.44 cm). (D) Fluid perilesional suffusion and fat inhomogeneity were appreciable (dashed arrow) , a hyperechoic spot was visualized in the middle center of the septum.

Fig. 2

Transabdominal ultrasound after emptying the bladder. The catheter balloon (c) was visible on the upper pole of the lesion, the hyperechoic catheter line run within the midline septum (white arrow). The fluid content is inhomogeneous (white asterix).

Fig. 3 (A-B)

Transvaginal ultrasound. At transvaginal ultrasound, a bilocular cyst with a non-vascularized septum (white arrowhead) (B), low level content and regular walls (white asterix), was visualized below the catheterized (c) bladder (b) and anterior lateral to the urethra (white arrow) (A). There was no communication between the cyst and urethra. Uterus (u).

Fig. 4

MRI. The bilocular fluid collection is located just laterally to the external urethral meatus and inferior to the pubic symphysis. (A) Coronal T2 Turbo-spin-echo sequence with selective fat suppression. (B) Coronal T2 Turbo-spin-echo sequence. The fluid filled collection with internal mildly heterogenous hyperintense signal (black asterix) is localized laterally to the urethra (white arrow), the catheter line (c) run in the middle. Bladder (b).

Fig. 5 (A)

Axial T2 Turbo-spin-echo sequence with selective fat suppression. The inhomogeneous bilocular fluid collection is localized around the urethra. Intense peripheral swelling was appreciable (black asterix). (B) Axial T1 vibe with selective fat suppression. The round image presented thick walls (white arrow), internal isointense to muscle signal. (C) Axial T1 vibe with selective fat suppression after contrast in venous phase, The walls appeared thickened and smooth (white arrow)