Prostatic Utricle Cyst Research Articles

304 - Endoscopic combined robotic-assisted excision of symptomatic prostatic utricle cyst

304 - Endoscopic combined robotic-assisted excision of symptomatic prostatic utricle cyst

Giant prostatic utricle cyst in a newborn with Simpson-Golabi-Behmel syndrome: Voiding cysturethrography essential for the diagnosis

Giant prostatic utricle cyst in a newborn with Simpson-Golabi-Behmel syndrome: Voiding cysturethrography essential for the diagnosis

Large prostatic utricle cyst with calculus in a child: a rare entity

Introduction: Prostatic utricle cyst (PUC) is a rare entity associated with congenital urogenital anomalies. In some cases, prostatic utricle is strikingly enlarged and present as a cystic lesion in perineum or in pelvic cavity posing diagnostic dilemma. Very few case reports are available in the published literature. Case report: We report a case of 12 year old male with complaints of post void dribbling of urine since birth and feeling of incomplete emptying. Clinical examination revealed ambiguous genitalia with perineal hypospadias and bilateral undescended testes. Ultrasound pelvis revealed a well-defined midline cystic lesion posterior to the urinary bladder with an intra-lesional calculus. MRI demonstrated a narrow communication tract between the cystic lesion and posterior urethra suggesting the possibility of PUC. Complete excision of the cyst was performed with ligation of the communicating tract and subsequent histo-pathological examination confirmed prostatic utricle cyst. Postoperative period was uneventful with complete resolution of the pre-operative symptoms. None of the symptoms recurred on follow up of the patient after three month of surgery. Conclusion: Prostatic utricle cyst should always be kept in the differential diagnosis of midline cystic lesions in young males specially if associated with uro-genital anomalies. Thorough clinical and imaging evaluation is needed to establish the diagnosis. MRI is the imaging modality of choice to differentiate utricle cyst from other midline cystic lesions of the pelvis.

Late Presentation of Posterior Urethral Valve with Giant Prostatic Utricle Cyst and Urethro-Ejaculatory Duct Reflux in an Adolescent Trisomy 21 Patient: Case Report

Late Presentation of Posterior Urethral Valve with Giant Prostatic Utricle Cyst and Urethro-Ejaculatory Duct Reflux in an Adolescent Trisomy 21 Patient: Case Report

A case of obstructive azoospermia secondary to genitourinary tract infection caused by a prostatic utricle cyst

A case of obstructive azoospermia secondary to genitourinary tract infection caused by a prostatic utricle cyst

Symptomatic prostatic utricle cyst: a case report

The prostatic utricle is a remnant of the Müllerian ducts and can be the site of a cyst that is usually asymptomatic and most often associated with hypospadias or other external genitalia anomalies. We report a rare case of a symptomatic prostatic utricle cyst revealed by lower urinary tract signs evolving since 3 months in a 19-year-old adolescent with cerebral palsy, without external genital anomalies. The diagnosis was confirmed by pelvic MRI, and the treatment consisted of transrectal ultrasound-guided aspiration with good clinical evolution.

Localization of external urethral orifice in coronary sulcus during urethroplasty in case of severe hypospadias accompanied by prostatic utricle cyst

BackgroundTo explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with prostatic utricle cyst (PUC) connecting to the vas deferens. Group A consisted of 3 patients with severe hypospadias and PUC undergoing cystostomy, hypospadias correction and urethroplasty, along with the relocation of the external orifice of the urethra to the coronal sulcus. Group B consisted of 4 patients having initial hypospadias repaired with meatus in the orthotopic position in the glans, presenting with multiple epididymitis after hypospadias surgery and unsuccessful conservative treatment. MR confirmed that all the Group B patients had PUC connecting to the vas deferens. Group B patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus.ResultsIn group A, 3 children underwent bladder fistula removal 2 weeks after the operation. The penis developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients in group B were followed without epididymitis recurrence.ConclusionsFor patients with hypospadias complicating with a PUC, connecting to one side of the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.

Adult residual rectourethral fistula and diverticulum presenting decades after imperforate anus repair: a\xa0case report

BackgroundThis report describes a rare surgical case of an intraabdominal mass in a middle-aged patient 40 years after imperforate anus repair.Case presentationA 44-year-old Latino male with history of repaired anorectal malformation presented with recurrent urinary tract infections and rectal prolapse with bothersome bleeding and fecal incontinence. During his preoperative evaluation, he was initially diagnosed with a prostatic utricle cyst on the basis of magnetic resonance imaging findings, which demonstrated a cystic, thick-walled mass with low signal contents that extended inferiorly to insert into the distal prostatic urethra. However, at the time of surgical resection, the thick-walled structure contained an old, firm fecaloma. The final pathology report described findings consistent with colonic tissue, suggesting a retained remnant of the original fistula and diverticulum.ConclusionsAlthough rare, persistent rectourethral fistula tracts and rectal diverticula after imperforate anus repair can cause symptoms decades later, requiring surgical intervention. This is an important diagnostic consideration for any adult patient with history of imperforate anus.

Surgical treatment for prostatic utricle cyst in children: A single-center report of 15 patients.

To report our single-center experience of the management of children with prostatic utricle cysts. We retrospectively analyzed 15 children who were incidentally found to have a prostatic utricle cyst and were admitted to our department between October 2013 and August 2020. Clinical characteristics and management were collected and catalogued. Recurrent genitourinary tract infections were the most frequent complaint, and two-thirds of patients also had hypospadias. A connection between the posterior urethra and the prostatic utricle cyst was found in all cases. Two patients directly had their progressively enlarging prostatic utricle cyst resected laparoscopically. Endoscopic techniques were used in 13 patients, two of whom underwent laparoscopic excision for repeated symptoms. The mean (range) follow-up period was 34.9 (2-82)months. No recurrences were observed in four patients who underwent prostatic utricle cyst excision and eight patients who received endoscopic treatment. Three patients had recurrent symptoms after endoscopic treatment and were managed by nonsurgical treatment. Prostatic utricle cyst is a rare disease which can cause recurrent genitourinary tract infections. Extra attention should be paid to evaluation for prostatic utricle cyst in children with external genital anomalies. Retrograde urethrogram and magnetic resonance imaging are useful tools with which to distinguish prostatic utricle cyst from other cystic lesions that are located in the midline pelvis in male patients. Individualized treatment is appropriate when considering fertility preservation, recurrences and malignancy. Laparoscopic excision is feasible for symptomatic and large prostatic utricle cyst. Regular long-term monitoring is recommended for all patients with prostatic utricle cyst.

Prostatic Adenocarcinoma presenting as Large Cystic lesion of Prostate - A Case Report

73 years old male presented with acute urinary retention. There was no history of lower urinary tract symptoms (LUTS) prior to this episode. On digital rectal examination he had a large nontender cystic swelling on anterior wall of rectum. His serum PSA was 62.36 ng/ml. After Imaging & fine-needle aspiration cytology (FNAC) he was diagnosed as a case of benign cyst likely prostatic utricle cyst. He was given a trial without catheter which failed, and He was managed with robot assisted laparoscopic excision of prostatic cyst. Histopathological examination of excised specimen revealed presence of Prostate Adenocarcinoma arising within cystic lesion.

Ruptured Prostatic Utricle Cyst – An Unusual Cause of Isolated Neonatal Urinary Ascites

Ruptured Prostatic Utricle Cyst – An Unusual Cause of Isolated Neonatal Urinary Ascites

Clear Cell Adenocarcinoma in Men: A Series of 15 Cases.

Clear cell adenocarcinoma (CCA) is a rare tumor in the genitourinary tract with female predominance and few reports in men. We identified 15 cases of CCA in men evaluated at our institution. Five arose in the bladder, 7 in the prostate or prostatic urethra, 2 in the membranous urethra (1 multifocal in the prostatic and membranous urethra), 1 periprostatic (likely from an embryologic remnant), and 1 between rectum and bladder (likely in a prostatic utricle cyst). No cases showed associated Müllerian structures. One case showed separate foci of nephrogenic adenoma at diagnosis, and 1 case showed urothelial carcinoma in situ on a later follow-up biopsy. Four tumors extended into other organs (prostate to seminal vesicle and periprostatic soft tissue, periprostatic soft tissue to prostate, prostatic urethra to bladder and rectum, and prostate to bladder neck). One tumor showed extraprostatic extension alone. Four tumors metastasized to lymph nodes, with 3 also metastasizing to other sites (bladder, lung and adrenal, and right flank). Eleven patients underwent resection, including 3 transurethral resections. Seven underwent other treatments, including radiation (5 [1 for recurrence]), chemotherapy (3), hormonal therapy (3), immunotherapy with nivolumab (1), and targeted therapy with gefitinib (1). The mean follow-up was 35 months (range: 1 to 138 mo). At the last follow-up, 7 patients showed no evident disease and 3 were alive with disease. Four died with the cause of death unknown, with 2 cases having confirmed disease at the time of death and the remaining 2 dying less than a year after diagnosis. The mean time to death was 16 months (range: 6 to 39 mo). No follow-up was available on 1 patient. All patients who died in this series had CCA of the prostate or prostatic urethra. Pathologists need to be attuned to CCA occurring in males, given that the literature emphasizes its occurrence in females. In addition to established sites such as bladder and urethra, our series demonstrates that tumor may present in unusual adjacent sites, such as in periprostatic embryologic remnants or prostatic utricle.

Robotic-assisted excision of a prostatic utricle cyst in a 12-month boy with proximal hypospadia and 45X0/ 46XY karyotype

Prostatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epididymitis. We present a 12 months boy we treated due to proximal hypospadias in two stages, in association to a dysplastic undescended testis that was excised. The karyotype of the patient was 45X0/46XY and after successful hypospadias treatment, the mother complained of purulent discharge in the diapers. A sonogram showed a large cyst behind the bladder with heterogeneous content. The diagnosis of utricle cyst was confirmed by a NMR with detailed anatomy and low confluence of the neck of the cyst to the urethra. We performed a robotic excision of the cyst consisting of careful dissection between bladder and rectum and a safe ligation of the communication of it to the urethra. Patient outcome was uneventful. To the best of our knowledge this is the youngest patient with utricle cyst treated with robotic approach reported in the literature.

Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study.

This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0–97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0–18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

Rare and special robotic surgery indications in the pediatric population: ectopic organs and differences of sexual development.

Differences of sexual development (DSD) affect the development of internal reproductive organs and external genitalia. Ectopic kidney is a rare and challenging pathology causing amongst others incontinence and recurrent urinary tract infections. Those pathologies may in certain cases be an indication for surgery. This manuscript aims to evaluate the role of robot-assisted laparoscopy in the surgical treatment of patients with ectopic kidneys or DSD. A prospective database is maintained in a tertiary referral center with all robotic surgeries performed in children. From this database, a prospective series of robot-assisted resection of embryologic remnants located in the pelvis was extracted: resection of a prostatic utricle cyst, removal of ectopic non-functional kidneys, and resection of a hemi-uterus. From an initial database including 72 patients, six patients met the inclusion criteria. Three male patients presenting with utricle cysts, two young girls presenting with ectopic kidneys, and one young boy with pelvic embryological remnants of the uterus, were further evaluated. Surgical treatment of patients with DSD is safe, feasible, and a good indication for robot-assisted laparoscopic surgery, as both deep dissection and reconstruction in a limited surgical field are requested.

LAPAROSCOPIC MANAGEMENT OF A GIANT PROSTATIC UTRICLE: A CASE REPORT AND REVIEW OF LITERATURE

Prostatic utricle is a Mullerian duct remnant with an incidence of 1 %. Excision of utricle is challenging because of the close proximity of seminal vesicle, ejaculatory ducts, bladder, rectum, ureter, and nerve plexus. Here, we report the case of a 23-year-old male presented with complaints of painful terminal hematuria associated with clots along with retrograde ejaculation. The abdominal and local examination was within normal limits. MRI pelvis showed a large non-communicating cystic structure present in the pelvic cavity, compressing posterior wall of the urinary bladder, seminal vesicle, anterior wall of the rectum and also causing left hydroureteronephrosis. After evaluation, the patient was diagnosed with giant prostatic utricle cyst. Laparoscopic excision of prostatic utricle cyst was done successfully. Postoperative period was uneventful and the patient was discharged in satisfactory condition. Laparoscopic excision of prostatic utricle cyst is technically challenging but with acceptable complications and good surgical results.

Transurethral ablation of a prostatic utricle cyst with the use of a holmium laser

To demonstrate a safe and effective approach to the treatment of obstructing midline prostate utricle cyst with the use of a holmium laser. Video presentation. University hospital. A 33-year-old man presented with chronic pelvic pain, pain with ejaculation, and infertility. Semen analysis demonstrated oligoasthenospermia with poor viability and computerized tomographic scan identified the presence of a midline 2-3-cm prostatic cyst with dilated seminal vesicles bilaterally. Transrectal ultrasound in the office confirmed the diagnosis of midline obstructing prostatic utricle cyst and estimated the distance from the urethra. Transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. Intraoperative technique highlighting the main steps for a transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. This video highlights the technique for transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser to unroof the cyst. Retrograde vesiculography was performed to confirm patency of the ejaculatory ducts. Outpatient surgery was tolerated well and the patient was discharged. After surgery at 4weeks, his symptoms had abated and semen analysis revealed normozoospermia. We demonstrate safe and effective transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. Preoperative transrectal ultrasound or cross-sectional imaging can be useful for operative planning. When the orifices of the ejaculatory ducts can be identified, vesiculography can be performed to confirm patency of the ducts and seminal vesicles after relief of the obstructing cyst.

Prostatic utricle cyst presenting with recurrent urethral discharge in the newborn: A case report

A 6 month old boy with normal external genitalia, presented with purulent urethral discharge from the neonatal period and recurrent urinary tract infections. Radiologic and urethrocystoscopic evaluation showed a midline structure connected to the prostatic urethra and discharging with pus. This structure, considered to be a prostatic utricle cyst was successfully drained endoscopically.

Effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction

Objective: To analyze the effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction. Methods: The clinical date of 56 cases of persistent hematospermia, or azoospermia/oligoasthenozoospermia from ejaculatory duct obstruction treated with transurethral seminal vesiculoscopy between November 2013 and January 2016 in the First Affiliated Hospital of Fujian Medical University were reviewed. A total of 30 cases were persistent hematospermia for 6 months to 3 years, with no response to routine antibiotic therapy for >4 weeks; 24 cases were obstructive azoospermia; and the other 2 cases were extreme oligoasthenozoospermia. Transrectal ultrasound of the prostate and seminal vesicles, and pelvic magnetic resonance imaging (MRI) were performed before the surgery, finding seminal vesicle dilation in 28 cases, ejaculatory duct dilation in 18 cases, seminal vesicle and ejaculatory duct dilation in 7 cases, seminal vesicle dilation with ejaculatory duct cyst in 2 cases, and bilateral ejaculatory duct dilation with prostatic utricle cyst in 1 case. After the transurethral seminal vesiculoscopy, follow-up examinations were performed to assess the effectiveness of the surgery for ≥3 months. Results: The surgery was successful in all the patients, with the duration of surgery ranging from 30 to 148 minutes. Among the 30 patients with hematospermia, calculi in ejaculatory duct or seminal vesicle was found in 20 cases, while inflammation or dark red jelly-like substances in seminal vesicle was seen in all cases. In the follow-up of 9.7 months (3.0-13.0 months), hematospermia in 26 (26/30, 86.7%)patients was relieved or cured after 1-6 times of ejaculation; the other 4 (4/30, 13.3%)cases still had hematospermia. In postoperative semen analysis for the 24 cases of azoospermia from ejaculatory duct obstruction, sperms were detected in 16(16/24, 66.7%)cases, but sperms were not found after 6 months following the surgery in 1 of the 16 case, thus re-obstruction was suspected; in the other 8 (8/24, 33.3%)cases, sperms could not be found in multiple semen analyses in >12 months after the surgery. The 2 cases of extreme oligoasthenozoospermia had obvious improvement in routine semen analysis in 1 and 3 months after the surgery. Except for 1 case of scrotum swelling after surgery, no postoperative complications (retrograde ejaculation, urinary incontinence, or rectal injury) were observed. Conclusions: Transurethral seminal vesiculoscopy was an effective therapy for persistent hematospermia. More strict operation indication and careful performance are necessary for azoospermia oligoasthenozoospermia from ejaculatory duct obstruction.

Prostatic utricle cyst with chronic prostatitis

Prostatic utricle cyst with chronic prostatitis