A 47-year-old woman presents with recurrent urinary tract infections, dysuria, dyspareunia, and intermittent dribbling of urine unrelated to coughing. Examination reveals a tender, cystic, midline swelling on the anterior vaginal wall about 3 cm from the introitus, which discharges pus on compression. The most likely diagnosis is:

• A Urethral diverticulum ✓
• B Skene gland abscess
• C Gartner duct cyst
• D Anterior vaginal wall cyst

Explanation

The classic triad of dysuria, dyspareunia, and postvoid dribbling (the three Ds) with a compressible anterior vaginal wall mass that discharges purulent material is characteristic of a urethral diverticulum arising from the periurethral glands. Recurrent cystitis results from stagnant urine pooling in the sac. A Skene gland abscess lies at the external meatus, not 3 cm up the wall, and lacks the voiding symptoms. A Gartner duct cyst arises from mesonephric remnants on the anterolateral wall and is asymptomatic unless very large.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.