Symptomatic Vaginal Masses Mimicking Prolapse: Varied Clinical Course, Diagnosis and Their Management

Abstract

Objective: The objective of this study was to study the different clinical presentation of symptomatic vaginal masses and outcomes of patients with important implications for surveillance, monitoring and management.

Methods: This was a retrospective chart review of 20 patients at a tertiary care centre with symptomatic vaginal masses other than prolapse presented between May 2021 and October 2023. Patients were included if they had symptomatic vaginal masses other than prolapse and underwent treatment for the same. Data were analysed by statistical software Stata 14.0. Descriptive statistics were computed to summarize the frequency of demographic and clinical variables. Quantitative variable expressed as mean ± SD (standard deviation) and median (minimum-maximum). Categorical variable expressed as frequency and percentage.

Results: The median age of the patients included in the analysis was 39.5 years old. A total of 15 patients underwent surgical management, which included vaginal excision or marsupialization, and 5 were conservatively managed. Presenting symptoms included feeling of a mass or bulge in 12 (60%) of patients, urinary complaint (n = 7; 35%) and dyspareunia (n = 1; 5%). Preoperative imaging studies were obtained in 19 patients; ultrasound was used in 95%, magnetic resonance imaging in 25%, computed tomographic scanning in 15% and multiple modalities in 20%. No patients were found to have other genitourinary anomalies. The average cyst size was 4.5 cm (range, 3-15 cm). Surgical excision was done in 15 cases except for 1 case of marsupialization. Histopathological examination showed that 2 solid masses had leiomyoma, seven patients had Gartner duct cyst and six patients reported Bartholin cyst. The median follow-up was 12 months (range, 3-21 months). During the follow-up period, one patient had persistent stress urinary incontinence (SUI), and the other one had persistent urinary urgency incontinence (UUI). Remaining patients were freed from preoperative presenting symptomatology. Neither had recurrence of the mass nor any complications were observed during the follow-up.

Conclusion: Vaginal masses are rare and often asymptomatic, but may present with varied clinical symptoms. They can be managed conservatively and surgically with good outcome. Follow-up is very essential to understand different clinical symptoms of vaginal masses.

Keywords: Bartholin; Cyst; Excision; Gartner duct; Prolapse; Symptomatic vaginal masses.