Recurrent cystitis is a common urological issue, but in some cases, an underlying periurethral abscess may be the root cause. This condition is often underdiagnosed, and even among urologists, there is limited awareness of its optimal treatment. This blog post explores the diagnosis and treatment of periurethral abscess, including a novel approach using laparoscopic surgery with fat grafting to promote tissue healing.

1. What Is a Periurethral Abscess?

A periurethral abscess is a localized bacterial infection that forms an abscess around the urethra. It can occur when periurethral glands (e.g., Skene’s glands) become infected, leading to abscess formation and chronic inflammation. If left untreated, it can result in urethral stricture, persistent urinary symptoms, or even urethral fistula formation.

Common Causes

• Recurrent urinary tract infections (UTIs)

• Urethral trauma (e.g., postpartum, catheterization, or post-surgical injury)

• Immunosuppression (e.g., diabetes, corticosteroid therapy)

• Extension of infection from Skene’s gland or Bartholin’s gland abscess

Symptoms

• Persistent dysuria (pain during urination)

• Urinary retention or weak urinary stream

• Swelling or tenderness around the urethra or perineum

• Recurrent UTI symptoms (frequency, urgency, residual urine sensation)

If left untreated, a periurethral abscess can rupture, leading to a urethral fistula or spread to surrounding tissues, causing pelvic cellulitis.

2. How Is a Periurethral Abscess Diagnosed?

Because the condition is rare and often overlooked, a combination of clinical assessment and imaging is crucial for diagnosis.

Clinical Examination

• Look for swelling, redness, or tenderness around the urethra

• Perform a bimanual vaginal/rectal exam to check for periurethral masses

Imaging Studies

• Ultrasound (US): Identifies abscess formation and evaluates vascular flow with Doppler

• MRI: Useful for assessing extent of inflammation, fibrosis, and abscess size

• CT scan (with contrast): Detects pelvic infection spread

• Voiding cystourethrogram (VCUG): Evaluates urethral fistula or stricture

Laboratory Tests

• Urine analysis & culture

• Abscess fluid culture to determine bacterial etiology

3. Treatment Strategies

The standard treatment for periurethral abscess involves a combination of antibiotics and drainage, but in recurrent or chronic cases, surgical intervention is often required.

① Antibiotic Therapy

For mild cases, broad-spectrum antibiotics such as cephalosporins or fluoroquinolones are used. However, multidrug-resistant bacteria (e.g., MRSA) can be involved, requiring culture-guided therapy.

② Abscess Drainage

If an abscess is large or recurrent, it should be surgically drained to prevent complications.

• Ultrasound-guided percutaneous drainage (minimally invasive option)

• Surgical incision & drainage (for large or recurrent abscesses)

③ Surgical Treatment

For cases with persistent infections or urethral fibrosis, surgical intervention is required.

• Laparoscopic abscess excision and drainage

• Tissue repair with fat grafting: Using bladder fat pad or autologous fat grafting to promote tissue healing and prevent urethral scarring

• Urethral reconstruction if stricture is present

Recent studies suggest that fat grafting around the urethra may improve healing, reduce fibrosis, and maintain urethral function.

4. Conclusion

Periurethral abscesses are an underrecognized cause of recurrent cystitis. Early diagnosis using ultrasound and MRI is essential, and treatment typically involves antibiotics and drainage. For recurrent or complex cases, laparoscopic surgery with fat grafting may offer a promising tissue-preserving approach to enhance urethral healing and prevent recurrence.

Since this condition is not widely known, increasing awareness among healthcare providers is crucial for early detection and effective management.