穆勒氏管囊腫造成的下泌尿道症狀：病例報告

簡佑軒、林友翔

林口長庚紀念醫院 外科部 泌尿外科

Lower urinary tract symptoms caused by Müllerian duct cyst: A case report

Yu-Hsuan Chien, Yu-Hsiang Lin

Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Introduction:

A Müllerian duct cyst is the persistent remnant of the Müllerian duct. Müllerian duct cysts are uncommon, with a reported prevalence of 1–5%. Reports of symptomatic cases are rare; signs and symptoms include perineal pain, dysuria, infertility, hematuria and genital inflammation.

Case presentation:

A 49-year-old male presented with complaints of suprapubic pain during urination, dysuria and nocturia for few weeks. After screening examination including bladder ultrasound, transrectal ultrasound and cystoscopy, a prostate intravesicle protrusion mass was found. Further magnetic resonance imaging revealed a midline intravesicle multiloculated cyst (3 cm) with thin wall and attached to bladder neck, suggestive of Müllerian duct cyst. The patient underwent laser prostatectomy with Thulium-Glass. Intraoperatively, cyst was seen extending form 10 o’clock to 2 o’clock position at bladder neck and some fluid was drained out endoscopically. Complete enucleation of cyst and prostate adenoma was done. Postoperative period was uneventful. On follow-up, a significant improvement of symptoms was achieved after surgery.

Conclusion:

Müllerian duct cysts result from a focal failure of regression and saccular dilatation of the paramesonephric duct. They usually present in the third to fourth decade of life. Most Müllerian duct cysts are asymptomatic but they may present with lower urinary tract symptoms including dysuria, decreased urinary flow rate, urinary frequency, urgency and nocturia. Transrectal ultrasound, computed tomography, and magnetic resonance imaging are the most useful diagnostic tools. Surgical excision of a Müllerian duct cyst may be performed depending on the size and location of the cyst and the presence of clinical symptoms. We can learn from this case that some rare congenital etiologies may also lead to lower urinary tract symptoms, especially in younger patient.