Hydatid Cyst of the Prostate Gland: A Review and Update

Abstract

Hydatid disease refers to a parasitic infestation that is caused by a tape worm of the genius Echinococcus. The disease, though more common in some parts of the world, occurs in most areas of the world due to global travel and affects approximately 1 million people. However, hydatid cyst of the prostate is very uncommon in many parts of the world to the extent that some clinicians would never encounter the disease. Hydatid cyst of the prostate may present with lower urinary tract symptoms, retention of urine, perineal pain during ejaculation and or defecation, recurrent epididymitis, haematospermia, pelvic pain, anejaculation, passing of soft grape-like material in the urine. Digital rectal examination would reveal an enlarged prostate and a cystic mass within the prostate pushing the urinary bladder upwards. Ultrasound scan of abdomen and pelvis, trans-rectal ultrasound scan, CT scan of abdomen and pelvis, MRI scan of abdomen and pelvis are radiology imaging options that are used to demonstrate the cysts within the prostate. Casoni test may be positive which may be suggestive of the disease but Casoni test may be negative. Treatment of the disease does include (a) utilization of systemic anti-helminthic medication plus either (b) [i]open surgical excision the cyst in the prostate; [ii] laparoscopic surgical excision of the prostatic cyst; [iii] trans-urethral resection of prostate; endoscopic incision of the cyst through the prostatic, urethra aspiration of the cyst, injection of scolicidal agent into the cysts cavity and suction of the remaining fluid and daughter cyst and excision of the cyst; or trans-ultrasound guided aspiration of the cyst plus injection of scolicidal agent into the cyst and re-aspiration /suction plus insertion of a drain. The outcome following treatment is usually good but recurrence could occur if systemic scolicidal agent is not used or scolicidal agent is not injected into the cyst or the cyst wall is not completely excised.