李亞哲、林昌德、張志洋

嘉義基督教醫院 外科部 泌尿科, 小兒外科

Ya-Che Lee¹, Chang-Te Lin¹, Chih-Yang Chang²

1. Divisions of Urology, Department of Surgery, Chiayi Christian Hospital

2. Divisions of Pediatric Surgery, Department of Surgery, Chiayi Christian Hospital

 

Cystic of prostatic utricle, a vestigial remnant of mullerian duct, is a rare condition in males. It is present in up to 4% and 1% in newborns and adults respectively. It is often asymptomatic and found accidentally with abdominal ultrasound, computerized tomography (CT), or magnetic resonance imaging (MRI). We present a case of prostatic utricle cyst associated with cryptorchidism and hypospadias.

A 2-year-old boy presented with left scrotal swelling, dysuria, and fever. He had a history of bilateral cryptorchidism and surgery for perineal hypospadias 2 months ago. The meatus was at ventral surface of glans and of adequate caliber. His laboratory investigations were within normal limits. After the physical examination, abdominal computed tomography was performed. Abdominal CT demonstrated a retrovesical cystic lesion of low density, in which a 1x 2.8cm was shown. The prostate and bilateral seminal vesicle glands were obscure (Fig. 1). Cystourethroscopy revealed a passable stricture in distal bulbar urethra and an opening at the verumontanum ending into a blind cavity. We inserted a 4Fr open-end ureteral catheter and 3ml contrast dye was injected through the catheter. Retrograde urethrography showed a blind ending oval shape structure with contrast filling posterior to the bladder, arising at the level of prostatic urethra (Fig. 2,3). A 10Fr Foley was inserted and add antibiotics with Tazocin 1125mg Q8H IVD for left epididymitis for 2 days. Patient was discharged, kept on regular follow-up and planned for surgical excision of utricle in future only if it becomes symptomatic.

Prostatic utricle cysts are embryologic remnants of the Mullerian duct system that communicate with the urethra. They affect predominantly males younger than 20 years. The incidence of prostatic utricle cyst is 11% to 14% in association with hypospadias or intersex anomalies and up to 50% in the presence of perineal hypospadias. A prostatic utricle cyst can have varied presentation ranging from asymptomatic to recurrent UTI, epididymitis, hematuria, pyuria, urinary incontinence, oligospermia, retention or constipation. Though CT can easily identify these cysts. Endoscopic cannulation of the utricular opening with contrast material infusion into the cyst is another method to accurately demonstrate the communication of the urethra with the mass, and can determine the anatomical relationship with surrounding structures with the mass, and can determine the anatomical relationship with surrounding structures. Treatment is recommended only for symptomatic lesions. Procedure options are transperineal or transrectal aspiration, endoscopic section of the utricle meatus and transurethral marsupialization, and open surgery.

Correct diagnosis of a median intraprostatic cyst relies essentially on the anatomic topography, the size of the lesion, and the demographic data. When benign lesion is strongly suggested, a conservative management and firm reassurance are sufficient.