Paraurethral cyst in female newborn: is surgery always advocated?

Paraurethral cysts in females are rare, particularly in the neonatal period. Only 49 cases have been previously reported in English literature. The choice of management for this lesion remains controversial. Surgical management has been advocated, but spontaneous regression has also been reported. The aim of the study was to clarify the natural course of paraurethral cysts in female neonates and discuss the proper choice of treatment.

Neonates who presented to our surgical unit with paraurethral cyst over a 5-year period (January 2000 through December 2005) were studied. The "nonoperative strategy" was indicated, and their clinical course and outcomes were examined.

Five consecutive patients with paraurethral cysts in female neonates were treated. There have been 5192 female births during the same period, and the incidence of paraurethral cyst was 1 in 1038 female births. None was associated with other anomalies. Clinical examination revealed interlabial cystic mass, which is spherical and yellowish in color, with dilated blood vessel on the anterior surface. It obscured both urethral meatus and vaginal orifice. However, there was no apparent voiding difficulty. These paraurethral cysts spontaneously disappeared at follow-up 76 to 304 days after birth.

Our data suggest that the number of reported case, being fewer than predicted, suggests that paraurethral cysts in female neonates are unrecognized. Paraurethral cysts are generally characterized by a completely asymptomatic lesion and have a high rate of spontaneously resolution. Thus, surgery (aspiration, marsupialization, or excision) should not be hurried, because natural resolution within a few months is the likely outcome.