Abstract| Volume 36, ISSUE 2, P187, April 2023

33. Case Report: Unusual Etiology of Anterior Vaginal Mass

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      Benign vaginal masses are relatively uncommon in adults, with an estimated incidence of 1.6% in an adult urogynecologic surgical population, and the incidence in adolescents is unknown. The most common midline anterior vaginal wall mass is a urethral diverticulum, but the differential diagnosis of anterolateral wall masses is broad and includes cysts of embryonic origin (Mullerian cysts, Gartner's duct cysts), Skene's duct cysts, epithelial inclusion cysts, endometriosis, leiomyoma, fibroma, and lipoma. We present a case of anterior vaginal wall mass due to a previously unreported etiology.


      Our patient is a 17 year-old nonbinary person with a history of chronic pelvic pain. Surgical history includes cystoscopy with bilateral injection of Deflux in 2018 for vesicoureteral reflux (VUR). They presented for LNG-IUD insertion under sedation and examination revealed a firm, smooth 1 cm nodule palpable in the midline anterior vaginal wall which was unable to be visualized on speculum exam. The remainder of the pelvic exam was typical and pelvic ultrasound showed a typical uterine shape without evidence of pelvic mass. Given its location in the anterior vagina, initial suspicion was for urethral diverticulum, thus the patient was referred to urology for consultation. The patient has a history of chronic dysuria and perineal pain, but no typical urinary symptoms of urethral diverticulum. Urology performed cystoscopy and examination under anesthesia in coordination with gynecology, which revealed mound-like prominences of both ureteral orifices consistent with prior bilateral Deflux injection. Digital manipulation of the vaginal mass during cystoscopy correlated with movement of the mounds of Deflux material.


      Benign vaginal masses are rare and poorly understood, especially in the adolescent population. A vaginal mass due to injection of Deflux material has not been previously reported. Injection of Deflux, a bulking agent composed of dextranomer microspheres suspended in hyaluronic acid, is an endoscopic method of correcting VUR. Compared to ureteral reimplantation, Deflux injection is safer and has few reported serious complications. Calcification of Deflux material can occur as early as 3 years following injection and may mimic a ureteral stone on imaging; there have otherwise been no reported long-term sequelae of calcification. The incidence of a palpable vaginal mass in patients with a history of Deflux injection may increase as this technique becomes more common and should be included in the differential diagnosis of vaginal mass in patients with a history of VUR.
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