Midline Prostatic Cysts Presenting with Chronic Prostatitis or Secondary Infertility and Minimally Invasive Treatment: Endoscopic or Laparoscopic Approach?

Hui-Hui Zhang,Fan Qi,Min-Feng Chen,Zhuo Li,Jun Wang,Xiong-Bing Zu

doi:10.4236/ss.2011.25061

Abstract

Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has little effect on the large cysts and cysts lying deeply, in contrast with the laparoscopic approach. Therefore, the selection of minimally invasive therapeutic approaches is important. The aim of this study is to describe our experience in the diagnosis and selection of minimally invasive treatment for midline prostatic cyst. Methods: 15 cases of midline prostatic cyst were studied.10 cases presented with prostatitis-like symptoms, 1 with dysuria and acute urinary retention, 3 with secondary infertility and the rest 1 with hemospermia. 6 patients presented with small cysts (≤2 cm × 2 cm) close to urethra and underwent transurethral unroofing. The other 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate received the laparoscopic excision. Results: The average duration of transurethral unroofing and laparoscopic excision was 39 mins and 118 mins respectively, whereas the average time of hospitalization was 2.7 days and 4.5 days respectively. After a follow-up of 21 months, all cases were treated successfully without complications and recurrence. Their prostatitis-like symptoms disappeared, and the three patients presented with secondary infertility achieved conception within one year after the operation. Conclusions: A midline prostatic cyst can present with chronic prostatitis-like symptoms and secondary infertility. It can be cured by minimally invasive treatments, but these procedures should be carefully selected according to the size and location of the cyst.

Highlights

Midline prostatic cysts are infrequent and mostly detected incidentally during physical examination
We find that the minimally invasive treatments are simple and effective therapeutic methods to relieve cyst-related symptoms and settle the problem of sterility caused by midline prostatic cyst
All 15 patients were divided into two groups according to the volume and location of the cyst estimated by preoperative transrectal ultrasound and CT or MRI. 6 patients with small cysts (≤2 cm × 2 cm) close to bladder neck or urethra underwent transurethral unroofing. 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate underwent the laparoscopic excision (Figures 1 and 2)

Summary

Introduction

Midline prostatic cysts are infrequent and mostly detected incidentally during physical examination. The widespread availability of transrectal ultrasound has led to an increase in diagnosis of prostatic cysts. It has been reported that midline prostatic cysts were observed in 7.6% of healthy men and 5% of symptomatic outpatients [1,2]. The enlarged prostatic cyst can compress the adjacent tissues, such as posterior urethra or bladder neck. The patient may suffer from lower urinary tract irritative or obstructive symptoms, epididymitis, perineal and/or inguinal pain [2], which is often misdiagnosed as

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