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Variation of sex differentiation
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Anne-Marie Amies Oelschlager, Margarett Shnorhavorian
Although differentiation into female was considered the “default” pathway previously, it is now clear that internal Müllerian development occurs due to the presence of multiple genes. In the typical female, the Müllerian (or paramesonephric) ducts, which originate from the coelemic epithelium, will elongate, invaginate, and migrate medially and form the fallopian tubes, uterus, cervix, and upper one-third of the vagina. The wolffian ducts involute in the absence of high levels of testosterone; the distal embryologic remnant is the Gartner duct. The two uterine horns will then join together and will fuse. The transverse and longitudinal vaginal septae will then resorb through the second trimester. The distal urogenital sinus separates into the urethra and distal one-third of the vagina in the female in the process of external genital development.
Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Multiple paraurethral Skene’s glands are related to the female urethra. There are paraurethral ducts that drain into the distal urethral lumen. Nabothian cysts are retention cysts in the cervix related to chronic cervicitis. Gartner’s duct cysts are found at the anterolateral aspect of the proximal third of the vaginal wall. Bartholin’s gland cysts affect the posterolateral aspect of the lower vaginal wall. Urethral diverticulum occurs at the posterolateral aspect of the mid-urethra.
Normal and abnormal development of the genitalia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Rebecca Deans, Sarah M Creighton
Parts of the Wolffian duct may fail to regress completely in females, presenting as cysts lateral to the Müllerian duct. Usually these are incidental findings and most are asymptomatic, although they can grow to be large. The epoophoron and paraoophoron can be found beside the ovary in the mesosalpinx. Gartner’s duct (the lower part of the Wolffian duct) cysts can occur anywhere from the broad ligament down to the vagina, and may present as vulval or vaginal masses. Wolffian remnants are also seen in the cervix. Very rarely, the Wolffian system may persist as the primitive mesonephric system draining functioning glomeruli, and an extra ureter can be found emptying into the vagina
Skene’s Gland Cyst – Case Report of a 2-Year-Old Girl
Published in Fetal and Pediatric Pathology, 2023
Patrícia Sousa, Susana Correia-de-Oliveira, Marcos Guimarães, Ângela Dias, João Moreira-Pinto
Differential diagnosis includes other entities affecting the urogenital tract, such as urethral diverticulum, urethral polyp, ectopic ureterocele, epithelial inclusion cyst, Gartner’s duct cyst, Mullerian duct cyst, Bartholin’s cyst, condyloma, lipoma and rhabdomyosarcoma of the vagina [2,11,12]. Clinical history and physical examination may be sufficient for diagnosis [10], but voiding cystourethrogram, ultrasound, cystoscopy and magnetic resonance imaging may be useful in excluding differential diagnoses [1]. Definitive diagnosis is offered by excision and subsequent anatomopathological identification of transitional or squamous epithelium lining the cyst wall, confirming the origin in the urogenital sinus [12–14]. There is no standardized approach to the treatment of Skene’s gland cysts [5]. Surgical excision usually provides complete resolution without complications, but treatment options also include observation, needle aspiration, partial excision, and marsupialization [6]. There is lacking evidence comparing outcomes of different management options and surgical approaches [15]. Occasionally, these cysts are self-limited, resolving without drainage [1]. An expectant approach is more common in neonates, particularly when associated with breast development and/or vaginal bleeding because of the possible relation to maternal estrogen [9]. In the case of Skene’s gland abscess, an antibiotic regimen may be indicated [4]. Prognosis is favorable - in a 3.5 year follow-up of 10 women submitted to Skene’s gland cyst excision no recurrence was observed [5].
Investigation of pelvic floor disorders
Published in Climacteric, 2019
Pelvic floor ultrasound can also be used to evaluate descent of the vaginal walls, the uterus, the small bowel, and the rectum. For women with anterior vaginal prolapse, ultrasound may distinguish between a true cystocele from other conditions such as urethral diverticulum, Gartner duct cyst, and anterior enterocele24. For those women with cystocele, ultrasound may distinguish between those who have cystourethrocele (Green type II cystocele) and those with an intact retrovesical angle (Green type III cystocele)37. The first is associated with good urine flow rates and USI, while the latter is associated with voiding dysfunction and a low likelihood of SUI38. Ultrasound can be particularly useful for women with posterior vaginal wall prolapse. In these cases, ultrasound may distinguish a true ‘rectocele’ due to the weakening of the rectovaginal fascia from an enterocele, a rectal intussusception, or just a deficient perineum. Rectal intussusception, a condition that is found in approximately 4% of patients in a urogyneoclogy clinic, is strongly associated with symptoms of obstructed defecation39. The preoperative diagnosis of this condition is important for planning the optimal surgical technique. Finally, on translabial ultrasound, a descent of the bladder of 10 mm and of the rectum or uterus >15 mm below the symphysis pubis at maximum Valsalva manoeuvre are strongly associated with POP symptoms and are proposed as cut-off values for the ultrasonic diagnosis of significant prolapse40,41.
A peri-urethral mass – what are the possible diagnoses?
Published in Journal of Obstetrics and Gynaecology, 2018
With this presentation, there are a number of possible differential diagnoses including cystocele, skene gland abnormality, leiomyoma, ectopic caeco-ureterocele, urethral caruncle, gartner’s duct cyst and gartner’s duct abscess. Rarely, malignant lesions present as periurethral masses, including adeno-, squamous cell and transitional cell carcinoma, histiocytoma, and sarcoma, and very rarely cancers in urethral diverticula (Blaivas et al. 2004). On the contrast MRI, the mass was uniformally enhanced, which indicated it was solid in nature and raised the possibility of a leiomyoma.