gms | German Medical Science

Introduction: Skene’s gland is considered to be the female version of the male prostate. We report a case of Skene’s gland hyperplasia where the serum prostate-specific antigen (PSA) level was measurable. Also, we review the literature on diagnosing and treating various benign and inflammatory lesions of Skene’s gland.

Material and methods: We searched Scopus, Web of Science, and PubMed for reports on non-malign lesions of the human Skene’s gland, excluding newborns and animals, from 1937 to September 2023.

Results: Lesions of Skene’s gland are uncommon, but we found 60 papers about benign lesions or inflammation, consisting mostly of small case series. The benign lesions are described as cysts, hyperplasia, tubular-squamous vaginal polyp, leiomyoma, adenofibroma, and lithiasis of Skene’s gland. Inflammatory lesions of Skene’s gland are described as abscesses or female prostatitis. Physical examination, ultrasound, cystoscopy, MRI, and micro-ultrasound can help in the differential diagnosis of these conditions.

The patient was a 91-year-old woman with a suspected bladder mass at the bladder trigone. Cystoscopy revealed the suspected lesion and an obstructed anterior bladder neck with a large mass located from a “7 o’clock” to “11 o’clock” area. The photodynamic diagnosis was negative. Transurethral subtotal resection of the mass was performed. The serum PSA level at the third postoperative day was 0.08 ng/mL. Postoperative cystography showed no contrast media extravasation. Thus, histopathology revealed massive adenomyomatous hyperplasia of the Skene’s gland as well as non-dysplastic urothelium and glandular and squamous epithelium. Immunohistochemistry showed strong PSA and NKX3.1 positivity, confirming the diagnosis of “female prostate”. FISH analysis showed only green signals that confirm an XX karyotype. In follow-up to 17 months, there was no disease recurrence or need for a urinary catheter.

Conclusion: These benign lesions can be treated successfully with prompt conservative or surgical treatment. Effective therapeutic strategies for Skene’s gland hyperplasia are unknown due to the absence of reported cases. Given the patient’s age, we assumed that bladder neck resection by transurethral resection with a controlled level of serum PSA would be a suitable therapeutic approach.