Subpubic Cartilaginous Cyst Presenting as Acute Urinary Retention: A Report and Review of the Literature

Introduction: A subpubic cartilaginous cyst is a rare and therefore poorly understood pathologic process involving the symphysis pubis. We describe a case of a postmenopausal female with acute urinary retention secondary to a periurethral cyst, and provide a literature review of previously reported cases of women with presenting complaints of a vulvar mass or pain. The differential diagnoses of a subpubic cartilaginous cyst, as well as management options, are discussed. Case: A 68-year-old woman presented with acute urinary retention. Physical examination revealed a 4-cm tender cystic mass palpated along the anterior vaginal wall traversing toward the posterior pubic ramus. A pelvic magnetic resonance imaging showed a 4.4 x 3.5 x 4.2-cm(3) well-circumscribed, cystic lesion at the anterior aspect of the lower urethra with no intrinsic contrast enhancement. The cyst was surgically excised through a transvaginal approach with no recurrence to date. Conclusions: A subpubic cartilaginous cyst is an uncommon lesion thought to originate from the symphysis pubis and to be a result of degenerative changes. Patients have presented with pain, a vulvar/vaginal mass, or both. This case describes a patient who presented with acute urinary retention. In patients with suspected subpubic cartilaginous cyst, the lesion may be excised in symptomatic patient or observed in those who are asymptomatic. Standard of care has not yet been determined regarding management due to the rarity of the lesion.