尤仲豪、歐穎倫、陳進利、蒙恩 

 國防醫學院三軍總醫院外科部泌尿外科 

 A rare huge perineal cyst leads elevated Prostate specific antigen level and severe lower urinary tract symptoms: a case report and and literature review

 Yu, Chung-Hao, Ying-Lun Ou1, Chin-Li Chen, En Meng

Divisions of Urology, Department of Surgery, Tri-Service General Hospital, Taiwan  

Abstract:  

Cysts of the lower genitourinary tract of male patients are uncommon and usually benign. There are different complications may associate with these cysts, such as pain, postvoiding incontinence, urinary tract infection, recurrent epididymitis, prostatitis, hematuria, hematospermia, and may also cause infertility.

We described a 63-year-old man who presented with a perineal cyst about 5 cm in size between the prostate and rectum noted while performing transrectal ultrasound of the prostate for evaluating the elevated PSA level(21ng/ml). Digital examination showed a soft mass located in front of the rectum and the prostate was not able to be well identified. Biopsy of prostate revealed few atypical glands and benign prostatic tissue. Persistent hematuria was noted one month after prostate biopsy. He underwent several times of percutaneous ultrasound guided aspiration of cyst and 2 times of 95% ethanol injection due to recurrent fluid accumulation. Drainage fluid cytology showed no malignant cell but many histiocytes, lymphocytes and PMNs were identified. One year later, the perineal cystic lesion became larger than before and the size was up to 9.3cm x 5.1cm. Hematuria accompanied with acute urine retention occurred. Furthermore, drainage fluid become turbid and pus like. We performed excision of perineal cyst via transperineal incision for the patient and no recurrence was founded after a three-month follow up.

Conclusion:

Perineal cyst compress prostate to relate high PSA level and LUTS is uncommon. Besides, carefully to doing TRUS biopsy of perineal cysts, complication of infection and hematoma maybe occurred.