Abstract
Prostatic utricle (PU) is incomplete regression of Müllerian duct and may cause recurrent urinary tract infections (UTIs), stone formation, postvoid dribbling, and recurrent epididymitis. Although surgical excision is recommended to avoid complications, surgical access to PU has been challenging. Cystoscopy-guided laparoscopic management of PU in a 3-year-old boy is reported to discuss use of other endoscopic aids in the surgical treatment of PU. He was admitted with disordered sexual development with karyotype of 47,XYY/46,XY and has been experiencing recurrent UTIs. Voiding cystourethrogram (VCU) demonstrated large PU (IKOMA II). Cystoscopy was performed confirming PU and the cystoscope was left in situ to aid laparoscopic exploration after bladder was emptied. A 5-mm umbilical port and two 5-mm ports in both lower quadrants were inserted. The peritoneum was dissected behind bladder. The cystoscope in PU was used as guidance in identification and dissection of PU. The vas deferens was identified and could be secured. The neck of PU was ligated with surgiloop. PU was retrieved from umbilical port. Postoperative VCU revealed normal posterior urethra. He has been free of UTIs for the last 6 months. Laparoscopy is safe and feasible alternative in surgical management of PU, by providing good visual exposure, easy dissection in deep pelvis, and improved cosmesis. The cystoscopic guidance is an important aid in identification and dissection of PU.
Highlights
A prostatic utricle (PU) is an enlarged diverticulum that communicates with the posterior urethra
Pelvic ultrasonography can identify a cystic mass behind the bladder, Voiding cystourethrogram (VCU) is the examination of choice for a precise PU diagnosis
Meisheri et al[5] recommends retrograde urethrography and cystoscopy in all proximal hypospadias cases and proposed a therapeutic algorithm based on the grade of the utricle
Summary
A prostatic utricle (PU) is an enlarged diverticulum that communicates with the posterior urethra. Several open surgical techniques have been described to date, including transperitoneal, perineal, posterior sagittal, and transvesical approaches[2,5]; most of these techniques are associated with the risk of damaging the pelvic structures, poor exposure, incomplete excision of the PU, and prolonged hospitalization.[3,6] Laparoscopic management of PUs is becoming more common as the surgical treatment of choice following Yeung et al’s3 report that laparoscopic excision of PUs facilitates good exposure and a low complication rate. We report the use of cystoscopy-guided laparoscopic excision of a PU in a male pediatric patient. A 3-year-old boy presented with disordered sexual development and the 47,XYY/46,XY karyotype He had penoscrotal hypospadias, bifid scrotum, and asymmetrical gonads. The parents of the patient provided written informed consent to use the patient’s clinical data for scientific purposes
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