Managing Cyst on the Glans: Surgical Options and Considerations

I want to address a cyst on the glans?

Hello Doctor: I have had a small blister on the glans since childhood, which is smooth and elastic on the surface.
I later learned that this is called a cyst.
Since I have already had two children, it should be harmless, but there is one thing that bothers me: because the blister is located at the urethral opening, I sometimes have to find the right angle when urinating, as the urine tends to split.
Additionally, it doesn't look good aesthetically.
I would like to ask the doctor:
1.
Is surgery necessary for this condition, and what is the general surgical procedure like?
2.
If it needs to be excised, will the urethra be affected as well? I am concerned because I have heard news reports about parents taking their children for circumcision, which resulted in the removal of a segment of the urethra (I am very scared).

3.
Since I also want to consider the aesthetic aspect, should I consult a urologist or a plastic surgeon?
4.
I have found some information indicating that there are surgical options and also options to aspirate the cyst fluid with a needle.
Is the aspiration method considered to be less risky?
5.
How common is this type of cyst? If surgery is required, will many doctors lack experience with this procedure?
P.S.
I found a photo that looks similar to my condition on this website: http://case.medlive.cn/derm/case-article/show-65965_232.html, and the description there is almost identical to my situation.
Thank you.

Mr. C, 30~39 year old female. Ask Date: 2015/07/29

Dr. Fu Shizhang reply Urology

Due to the relationship between the size and location of the cyst, it is recommended to visit an outpatient clinic for examination in order to address the issue.
You may start by consulting a urologist.

Reply Date: 2015/07/29

More Info

Managing a cyst on the glans, particularly one that is causing discomfort or aesthetic concerns, is a topic that requires careful consideration of surgical options and potential outcomes. Here’s a comprehensive overview based on your questions.

1. Surgical Necessity and Procedure:
While many cysts, especially those that are asymptomatic, may not require surgical intervention, your situation—where the cyst is affecting urination and causing cosmetic concerns—may warrant surgical removal. The typical procedure involves local anesthesia to numb the area, followed by an incision to excise the cyst. The surgeon will carefully remove the cyst and its capsule to minimize the risk of recurrence. The incision is then closed with sutures. The procedure is generally straightforward and can often be performed on an outpatient basis.

2. Risk of Urinary Tract Injury:
Concerns about damaging the urethra during cyst removal are valid, especially given your reference to unfortunate incidents in the media. However, experienced urologists or surgeons specializing in this area are trained to avoid such complications. During the procedure, the surgeon will take great care to identify and preserve the urethra. If the cyst is located very close to the urethra, the surgeon may use imaging techniques or careful dissection to ensure that the urethra is not compromised.

3. Choosing the Right Specialist:
For a cyst located on the glans, it is advisable to consult a urologist. Urologists specialize in the urinary tract and male reproductive organs and are well-equipped to handle conditions involving the glans and urethra. While plastic surgeons can also address cosmetic concerns, a urologist will have the specific expertise required for your condition.

4. Aspiration vs. Excision:
Aspiration, or using a needle to withdraw the cyst fluid, is a less invasive option that can provide temporary relief. However, it does not remove the cyst wall, which means the cyst can recur. Excision is more definitive and reduces the likelihood of recurrence. While aspiration may seem less risky, it is essential to consider that it may not resolve the underlying issue.

5. Prevalence and Surgical Experience:
Cysts on the glans are not uncommon, and many healthcare providers encounter them regularly. While it’s true that not all surgeons may have extensive experience with this specific procedure, urologists typically perform such surgeries frequently. It’s important to choose a surgeon who has a good track record with similar cases. You can ask about their experience and the number of similar procedures they have performed.

In summary, if the cyst is causing issues with urination and you are concerned about its appearance, surgical removal is a reasonable option. Consulting a urologist will provide you with the best guidance tailored to your specific situation. They can explain the risks and benefits of the procedure, discuss the likelihood of complications, and help you make an informed decision. Remember, it’s crucial to communicate your concerns and expectations clearly with your healthcare provider to ensure the best possible outcome.

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