A Suburethral Abscess Mimicking An Anterior Vaginal Wall Prolapse: A Case Report

Introduction: Anterior vaginal wall prolapse (AVWP), previously known as cystocele, is a herniation of the anterior vaginal wall and the bladder. It is a multifactorial pathology. Patients with AVWP may report a feeling of pelvic pressure and something bulging out of the vagina, urinary incontinence, and dyspareunia which are nonspecific symptoms. Case: A 73-year-old married Turkish G4P4 female who has been menopausal for 20 years, presented to the outpatient clinic with dysuria and urinary incontinence lasting for two weeks, and a palpable mass located in the genital area for 2 years. On her vaginal examination, the vagina and cervix appeared normal, and a grade 3 AVWP along with a semi-mobile mass extending from the distal urethra to the bladder base under the cystocele pouch was observed. She was diagnosed with a grade 3 AVWP with a plan for the surgical excision. A bilobular cystic mass was observed under the urethra, extending to the bladder wall with a size of 4-5 cm. The macroscopic examination showed a membraneous tissue piece of 4.5 x 2.8 x 2 cm, and the microscopic examination revealed a caseified granulomatous inflammation. Upon the suspicion of tuberculosis, we referred her to the infectious diseases (ID) clinic. Her PPD test was 0 mm. She had no complaints of active tuberculosis. She presented to our clinic with urinary incontinence. On her vaginal examination, involuntary leakage of urine with bladder stimulation was observed. We planned the implantation of transvaginal tape (TVT). Discussion: We believe that this case will help establish an idea about the differential diagnosis of AVWP. The differential diagnosis should include the other possible genitourinary pathologies due to the close proximity of the anterior vaginal wall to the bladder and the urethra before ensuring the diagnosis of the AVWP in order not to misdiagnose.