Severe lower urinary tract symptoms due to anteriorly located midline prostatic cyst arising from the bladder neck in a young male: case report.

Ali Gürağaç,Zafer Demirer,Bilal Fırat Alp,Emin Aydur

doi:10.1590/1516-3180.2016.0056280516

Ali Gürağaç, Zafer Demirer + Show 2 more

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https://doi.org/10.1590/1516-3180.2016.0056280516

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Abstract

Prostatic cysts are uncommon. These cysts are usually asymptomatic and are diagnosed incidentally during ultrasonographic examination. On rare occasions, they may cause drastic symptoms. We report on a case of severely symptomatic anteriorly located prostatic cyst arising from the bladder neck in a 30-year-old man presenting with lower urinary tract symptoms, without clinical evidence of benign prostatic hyperplasia. Transrectal ultrasonography (TRUS), computed tomography (CT) and cystourethroscopy demonstrated a projecting prostatic cyst that occupied the bladder neck at the precise twelve o'clock position. It was acting as a ball-valve, such that it obstructed the bladder outlet. Transurethral unroofing of the cyst was performed and the patient's obstructive symptoms were successfully resolved. Histopathological examination indicated a retention cyst. It should be borne in mind that midline prostate cysts can be a reason for bladder outlet obstruction in a young male. Such patients may have tremendous improvement in symptoms through transurethral unroofing of the cyst wall.

Highlights

Over recent years, the widespread availability of transrectal ultrasound (TRUS), computed tomography (CT) and magnetic resonance imaging (MRI) has led to increased frequency of diagnoses of incidental prostatic cysts
We report on the case of a severely symptomatic, anteriorly located prostatic cyst arising from the bladder neck in a 30-year-old man who presented with lower urinary tract symptoms (LUTS), without any clinical evidence of benign prostatic hyperplasia or any endoscopic management
DISCUSSION lower male genitourinary tract cystic lesions are uncommon and usually benign, they may be associated with a variety of genitourinary abnormalities and symptoms, such as urinary tract infection, chronic pelvic pain syndrome, postvoiding incontinence, recurrent epididymitis, prostatitis, obstructive and/or irritative voiding symptoms, hematospermia, low semen volume, ejaculatory pain, or even infertility.[2,3,4,9,13]

Summary

INTRODUCTION

The widespread availability of transrectal ultrasound (TRUS), computed tomography (CT) and magnetic resonance imaging (MRI) has led to increased frequency of diagnoses of incidental prostatic cysts. We report on the case of a severely symptomatic, anteriorly located prostatic cyst arising from the bladder neck in a 30-year-old man who presented with lower urinary tract symptoms (LUTS), without any clinical evidence of benign prostatic hyperplasia or any endoscopic management. Despite alpha blocker drug treatment, his symptoms had worsened His medical history was not significant in terms of previous urethral catheterization, urinary tract infection, pelvic/perineal trauma or neurological deficit. The patient underwent cystourethroscopy examination under general anesthesia This showed that the posterior wall of the prostatic urethra was normal and that there was cystic hemispherical bulging based on the anterior portion of the prostate. The bulge was located on the bladder neck at precisely twelve o’clock and was entirely compressing the bladder outlet It was acting like a ball-valve, without lateral lobe hyperplasia (Figure 3). The patient had no symptoms suggestive of erectile dysfunction or ejaculation disorders

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