Utricular Cyst Research Articles

More Than Detection of Adenocarcinoma - Indications and Findings in Prostate MRI in Benign Prostatic Disorders.

Multiparametric MRI of the prostate has become a fundamental tool in the diagnostic pathway for prostate cancer and is recommended before (or after negative) biopsy to guide biopsy and increase accuracy, as a staging examination (high-risk setting), and prior to inclusion into active surveillance. Despite this main field of application, prostate MRI can be utilized to obtain information in a variety of benign disorders of the prostate. Systematic bibliographical research with extraction of studies, national (German) as well as international guidelines (EAU, AUA), and consensus reports on MRI of benign disorders of the prostate was performed. Indications and imaging findings of prostate MRI were identified for a) imaging the enlarged prostate, b) prostate MRI in prostatic artery embolization, c) imaging in prostatitis and d) imaging in congenital anomalies. Different phenotypes of the enlarged prostate that partly correlate with severity of symptoms are discussed. We provide an overview of the different types of prostatitis and possible imaging findings, highlighting abscesses as a severe complication. The most common congenital anomalies of the prostate are utricular cysts, whereas anomalies like aplasia, hypoplasia, and ectopia are rare disorders. Knowledge of indications for imaging and imaging appearance of these conditions may improve patient care and enhance differential diagnosis. · Current guidelines do not implement indications for mpMRI apart from prostate carcinoma.. · MRI can distinguish different anatomical phenotypes of prostatic enlargement.. · Prostatic artery embolization represents a valuable treatment option in cases of symptomatic benign prostatic enlargement.. · Different forms of prostatitis exist and may mimic prostate carcinoma in MRI.. · MRI can be used to evaluate anatomical prostate anomalies.. · Oerther B, Sigle A, Franiel T et al. More Than Detection of Adenocarcinoma - Indications and Findings in Prostate MRI in Benign Prostatic Disorders. Fortschr Röntgenstr 2022; 194: 481 - 490.

Transrectal Ultrasonography Findings in Cases of Premature Ejaculation

Transrectal Ultrasonography Findings in Cases of Premature EjaculationAbstract:Background:Premature ejaculation (PE) seems to be the most common sexual complaint in men. A prostatic inflammation is a knowncause of PE.Transrectal ultrasonography (TRUS) is widely used to help in the management of both benign and malignant diseases of the prostate. Aim of work:To discuss TRUS findings in cases of PE. Subjects and methods:A case control study carried out on 24 married adult male patients with age ranged from 25 to 53 years, diagnosed with PE, attending our outpatient clinic at the Department of Urology, Faculty of Medicine, Zagazig University Hospital for the first time from October 2018 to June 2019. Full medical history was taken from all patients. All patients underwent a complete andrological and physical examination.Evaluation of prostate and seminal vesicles was done via transrectal ultrasound scanning methods. Results:The TRUS findings of prostate showed that the volume of prostate among the studied cases ranged from 13.2 to 39.2 ml with mean 27.65 ml. 20.8% had calcification, 37.5% had inhomogeneous prostatic texture and only 4.2% had utricular cyst. The TRUS findings of seminal vesicle (SV) among the studied cases showed that total volume ranged from 4 to 9.5 ml with mean 6.55 ml. Conclusion:The TRUS of SV must be considered in the clinical assessment of patients with PE. SVs can be of a valuable target for the treatment of patients with PE and ultrasound changes in SV.

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.

P-02-44 Implications of Multiparametric Prostate MRI in Patients With Hematospermia

Hematospermia is a benign condition that is rarely associated with significant disease and the need to exclude malignanancy is controversial. In this context we aimed to evaluate multiparametric prostate MRI (MP-MRI) findings in patients with hematospermia. In this prospectively managed retrospective study, twenty-three patients with hematospermia received 3T MP-MRI between October 2017 and September 2019. We also studied prostate-spesific antigen (PSA), mycobacterium tuberculosis DNA-polymerase chain reaction (TB-PCR) in the urine and urine analysis/culture. Median age was 49 (Range 30-73). No patient had gross hematuria episodes or a family history of prostate cancer or was using anticoagulants. Past medical history revealed chronic prostatitis (2) and epididimitis (2) in a total of 4 patients. All patients had normal digital rectal examination. Median PSA was 0.88 ng/ml (Range 0.6-5.4). TB-PCR and urine analysis/culture test were negative for all patients. Four (17%) patients had utricular cyst on MP-MRI imaging. MP-MRI revealed PI-RADS 1, PI-RADS 2, PI-RADS 3 and PI-RADS 4 lesions in 3 (13%), 13 (57%), 3 (13%) and 4 (17%) patients, respectively. All PI-RADS 2 and PI-RADS 3 lesions were commented as either focal chronic prostatitis or fibrosis by uroradiologist. Three patients with PI-RADS 3 lesions and low PSA values (< 1 ng/ml) were recommended PSA follow-up only. Patients with PI-RADS 4 (Mean PSA: 3.65 ng/ml (range: 1.58-5.39)) underwent cognitive MRI-guided biopsy. One patient (PSA 2.7 ng/ml) was diagnosed with a Gleason 3+4 prostate cancer.

尿路感染症を契機に発見された前立腺小室囊胞の1 例

前立腺囊胞性疾患は，外表奇形の合併がない場合，幼少期に発見されることは稀な疾患である。今回我々は，尿路感染症を契機に画像検査で偶発的に発見された前立腺小室囊胞の1 例を経験した。症例は1 歳男児。発熱と排尿時の啼泣，異常な尿臭を主訴に当科を受診した。膿尿の他，腹部の造影CT 検査と造影MRI 検査で膀胱と直腸の間に長径約40 mm の囊胞性病変を認めた。抗菌薬による治療で尿路感染症は改善し，その後の膀胱尿道鏡検査で前立腺小室囊胞と診断された。抗菌薬の予防投与で経時的に囊胞は縮小し，画像検査で確認できなくなったため，外科的切除は行っていない。現在，予防内服中止から1 年以上経過したが，再発は認めていない。小児の尿路感染症では，しばしば尿路異常を合併する例があるため，発症時には腎尿路系の精査を行うことも多い。自験例のように，前立腺小室囊胞が尿路感染症の合併症の1 つとして関与することを念頭に置く必要がある。

Case report of a combined prostatic and utricular cyst

A 16 year old previously well boy presented with voiding difficulty that progressed to intermittent retention over a two month period. A renal ultrasound showed a structure consistent with a utricular remnant behind the base of the bladder that endoscopically appeared to terminate in the posterior wall of the prostatic urethra as a cystic, enlarged verumontanum. Following an uneventful endoscopic fulguration of the anterior wall, the boy remained catheterized overnight. The following day the catheter was removed at the time of a radiologic study of the lower urinary tract, which showed a dilated posterior urethra, but no reflux into the tubular retro-vesical structure that was noted to have emptied on a post-operative ultrasound.

V3-11 SURGICAL MANAGEMENT OF EJACULATORY DUCT OBSTRUCTION DUE TO PROSTATIC UTRICULAR CYST

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2016V3-11 SURGICAL MANAGEMENT OF EJACULATORY DUCT OBSTRUCTION DUE TO PROSTATIC UTRICULAR CYST Phil Bach, Filipe Tenorio Lira Neto, Ryan Chuang, Bobby Najari, Richard Lee, Philip Li, and Marc Goldstein Phil BachPhil Bach More articles by this author , Filipe Tenorio Lira NetoFilipe Tenorio Lira Neto More articles by this author , Ryan ChuangRyan Chuang More articles by this author , Bobby NajariBobby Najari More articles by this author , Richard LeeRichard Lee More articles by this author , Philip LiPhilip Li More articles by this author , and Marc GoldsteinMarc Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1531AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Azoospermia is present in 10-15% of infertile men and can be divided into two broad categories: obstructive azoospermia (OA) and non-obstructive azoospermia. OA accounts for approximately 40% of azoospermia cases and can be caused by a blockage anywhere along the male reproductive tract. 5% of OA cases are secondary to ejaculatory duct obstruction, which may be caused by a variety of congenital or acquired etiologies. The mainstay of management for ejaculatory duct obstruction is transurethral resection of the ejaculatory ducts (TURED). We present the case and surgical management of a man with primary infertility secondary to ejaculatory duct obstruction caused by a prostatic utricular cyst. METHODS A 38 year old man with primary infertility presented with low semen volume, severe oligospermia and highly elevated sperm DNA fragmentation. He had an unremarkable physical exam, normal hormone levels, and a midline utricular cyst on both transrectal ultrasound and MRI, suggestive of ejaculatory duct obstruction. In the operating room, we successfully retrieved abundant highly motile sperm from both testes and vasa deferens. Next, to assess patency, we injected indigo carmine into the right vasotomy site and noted the dye coming out of the left vasotomy site, suggesting that both vasa deferens emptied into a common, obstructed cavity. A vasogram with water soluble contrast subsequently revealed bilaterally patent vasa deferens emptying into an obstructing midline utricular cyst. A TURED was carefully performed using a 24-Fr resectoscope while indigo carmine was instilled into both vasa deferens. Once inside the cyst, both ejaculatory ducts were visualized and a number of small stones were flushed out. A Foley catheter was placed for 24 hours and the patient instructed to ejaculate frequently to maintain patency of the freshly resected cyst. RESULTS Following the resection, indigo carmine could be seen flowing freely from a widely patent outflow tract. The patient tolerated the procedure well and was discharged home without complications. The sperm retrieved from the testes and vasa deferens had significantly lower DNA fragmentation than the ejaculated sperm and is currently being used for in vitro fertilization. Results from a follow-up semen analysis are pending. CONCLUSIONS While uncommon, ejaculatory duct obstruction due to midline utricular cyst is highly amenable to surgical management with TURED. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e470 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Phil Bach More articles by this author Filipe Tenorio Lira Neto More articles by this author Ryan Chuang More articles by this author Bobby Najari More articles by this author Richard Lee More articles by this author Philip Li More articles by this author Marc Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Verumontanum Cyst Associated With Lower Urinary Tract Symptoms in an Adolescent

Urinary tract polyps occur anywhere from the renal pelvis to the anterior urethra. Lower tract polyps occur less frequently than upper tract polyps and are a rare finding in children. Symptoms include obstruction, dysfunctional voiding, or hematuria. We report the case of a 17-year-old male who presented with persistent leakage of urine following voiding. Ultrasound demonstrated a small cystic lesion in the posterior aspect of the prostate and a voiding cystourethrogram was suggestive of a utricular cyst or polyp. He underwent a cystoscopy that demonstrated a large cystic structure originating from the verumontanum, nearly obstructing the prostatic urethra.

Management of ureteral obstruction with daVinci laparoscopic surgery

Management of ureteral obstruction with daVinci laparoscopic surgery

Kyste rétroprostatique drainant les canaux éjaculateurs avec azoospermie obstructive secondaire

Obstructive azoospermia constitutes 35 to 40% of azoospermia. Etiologies may be acquired or rarely congenital. Congenital utricular or Mullerian duct cyst may result in compression of ejaculatory ducts. However, they must be differentiated from exceptional wolffian or urogenital cysts, which are located at the same site but in which ejaculatory ducts may drain inside. We report a case of retroprostatic duct cyst diagnosed during work up of male infertility where magnetic resonance imaging (MRI) showed the drainage of both ejaculatory ducts inside and the presence of a thin canal ended blindly in the wall of prostatic urethra. Transurethral resection guided by MRI has been performed resulting in urethral drainage of the cyst, relieving of obstruction and normalization of spermogramm.

Clinical analysis of the characterization of magnetic resonance imaging in 102 cases of refractory haematospermia

To analyze the pathogenesis of persistent and refractory haematospermia and to evaluate the aetiological diagnostic value of magnetic resonance imaging (MRI) for this type of haematospermia. Clinical data from 102 patients with persistent and refractory haematospermia was retrospectively analysed. Data collected included history, symptoms, as well as ultrasound and MRI of the morphological features of the bilateral seminal vesicles (SV) and ejaculatory duct (ED) areas. Criteria for inclusion were haematospermia symptoms that occurred more than six times, that lasted more than 6months, and that did not improve after >1month of conservative treatment. Patients underwent seminal vesiculoscopy with a post-surgery follow-up of 3-48months [average (18.1±10.3) months]. Of the 102 patients that underwent MRI examination, data from 88 patients (86.3%) showed typical and characteristic changes in the ED area, including the signal intensity changes in 60 (58.8%), SV volume changes in 32(31.4%), the formation of cysts such as prostatic utricular cysts in 27 (26.5%), Müllerian cysts in 4 (3.9%), ED cysts in 5 (4.9%) and a SV cyst in 1(1.0%). The MRI findings were confirmed by seminal vesiculoscopy and all patients received appropriate treatment. In 14 patients (13.7%), no obvious abnormal changes were observed with MRIs, however, these patients were diagnosed and successfully managed using seminal vesiculoscopy. Some degrees of ED obstruction was usually found during surgery. The symptoms of haematospermia disappeared 1-2months after surgery in all patients. Two patients had a recurrence of haematospermia, underwent the same treatment, and recovered during the follow-up period. The aetiology of the most cases of the refractory haematospermia can be distinguished using the three-dimensional MRI. Typical abnormalities observed on MR images are signal intensity, SV volume changes and cyst formation. MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment of patients with persistent and refractory haematospermia.

Chronic Epididymitis with Scrotal Vasocutaneous Urinary Fistula

Chronic Epididymitis is a relatively rare problem in boys and is often enigmatic in its etiology. It is often associated with urinary tract abnormalities in infants and prepubertal children. This report describes a rare and unusual case of a chronic epididymitis with acquired scrotal vasocutaneous urinary fistula in an 8-mo-old boy who was found to have a large prostatic utricular cyst and ectopic vas insertion. The authors discuss embryology, pathophysiology, diagnostic dilemma and different treatment options.

Robot-Assisted Laparoscopic Excision of Symptomatic Retrovesical Cysts in Boys and Young Adults

We review our surgical experience with the management of retrovesical cystic anomalies using robot-assisted laparoscopic techniques. We retrospectively reviewed the presentation, diagnosis and treatment of 6 patients 28 months to 22 years old with retrovesical cystic anomalies who underwent robot-assisted laparoscopic excision at our hospital between January 2006 and November 2010. Presenting signs and symptoms included urinary retention, lower urinary tract symptoms, abdominal pain and repeated epididymitis. Associated anomalies consisted of hypospadias, vesicoureteral reflux, renal agenesis, 5alpha-reductase deficiency, premature adrenarche and cryptorchidism. Cystic anomalies ranged from 3 to 6 cm long. The final diagnoses were prostatic utricular cyst, müllerian duct cyst and seminal vesicle cyst. Ectopic insertion of vas into the cyst was found in 4 cases, requiring ligation of the affected vas in 3. Mean ± SD operative time including cystoscopy was 198 ± 23.8 minutes, and estimated blood loss ranged from 5 to 10 ml. Mean ± SD hospital stay was 1.33 ± 0.52 days. All patients had resumed their regular activities within 2 weeks postoperatively. De novo contralateral epididymitis developed 2 months postoperatively in 1 patient. Otherwise, there was no recurrence of cystic mass or presenting signs or symptoms during followup of 3 to 56 months. In the management of retrovesical cystic anomalies robot-assisted laparoscopic excision affords a natural extension of conventional laparoscopy with the additional advantages of 3-dimensional vision and ease of instrument control.

Bladder Outlet Obstruction due to an Unusual Prostatic Midline Cyst in an Adolescent Male

Most prostatic midline cysts, i.e., Müllerian duct cysts or prostatic utricular cysts, probably result from incomplete regression of the Müllerian duct remnant. Congenital cysts may be associated with other urogenital anomalies. Related symptoms include bladder outlet obstruction, hemospermia, ejaculatory-fertility impairment, and recurrent epididymitis. We report an adolescent male who presented with difficulty urinating that lasted for 2 months. After a complete survey with a urodynamic study, ultrasonography, urethrography, urethrocystoscopy, and computed tomography, a prostatic midline cyst with bladder outlet obstruction was identified. Using transurethral cyst unroofing, urination conditions improved according to the International Prostate Symptom Score and a uroflow study. Although there are various surgical interventions for a prostatic midline cyst near the urethra, endoscopic procedures are a safe and elegant alternative compared with other procedures.

Transrectal ultrasound in patients with hematospermia

Introduction To illustrate the lesions detected with transrectal ultrasound (TRUS) in patients with hematospermia. Material and methods This study included 74 male patients (25–73 years old) affected by hematospermia. Clinical history was obtained and all patients underwent rectal examination as well as TRUS examination in both axial and coronal planes to evaluate the prostate, ejaculatory ducts and seminal vesicles. Biopsy was performed in 10 patients. Results Abnormalities were detected in 59 patients. Calculi ( n = 20) were seen within the prostate, seminal vesicles and along the course of the ejaculatory ducts. Chronic prostatitis ( n = 14) appeared as hyperechoic and hypoechoic areas within the prostate with capsule thickening suggesting seminal vesiculitis ( n = 8). Granulomatous prostatitis ( n = 3) appeared as hyperechoic and calcified areas scattered within the prostate and the seminal vesicles. Hypoechoic focal lesions and heterogeneous texture were seen in prostate cancer ( n = 5). Utricular cysts (n = 3) appeared as small midline lesions, and Mullerian duct cysts ( n = 8) appeared as larger midline cysts protruding above the prostate. Ejaculatory duct cysts ( n = 4) appeared as thick walled cystic lesions along the course of the ejaculatory duct. Seminal vesicle cysts were detected in 2 patients. Conclusion Our conclusion is that TRUS is a safe, non-invasive technique which can be used to detect lesions of the prostate, seminal vesicles and the ejaculatory ducts in patients with hematospermia.

A CLINICAL ENTITY OF CYSTIC DILATATION OF THE UTRICLE ASSOCIATED WITH HEMOSPERMIA

We investigated the mechanism of hemospermia in patients with a midline cyst (MLC) of the prostate, focusing on cystic dilatation of the utricle (CDU) as a possible causative lesion. Of 138 patients with hemospermia 30 (22%) had an MLC, of whom 19 underwent transperineal needle aspiration of the MLC and bilateral seminal vesicles to determine the site of bleeding. Following MLC aspiration a mixture of dye and contrast medium was injected. The verumontanum was observed endoscopically and pelvic x-ray was done. Seminal vesicle fluid on 1 or 2 sides was hemorrhagic in 13 of the 19 patients (aspiration failed in 6) and fluid from the MLC was nonhemorrhagic in 5 of the 19 (aspiration failed in 7). The MLC communicated with the urethra (CDU) in 15 patients (79%) and with 1 or 2 ejaculatory ducts in 11 (58%). In 5 of 11 patients with communication with the ejaculatory duct hemospermia persisted for more than 1 year. Four of these patients were cured by transurethral unroofing of the CDU. CDU is a significant underlying lesion for hemospermia. Communication with the ejaculatory ducts was frequent in patients with chronic hemospermia and transurethral unroofing was effective for eliminating hemospermia.

Anatomical and histological studies of so‐called Müllerian duct cyst

We examined so-called Müllerian duct cysts both histologically and immunohistochemically with anatomical observation to investigate the etiology of the 'Müllerian duct cyst'. Five cystic lesions located in the prostatic midline were obtained from surgical specimens. A communication between the cystic lesion and the urethra via the utricular orifice was looked for and the specimens were subjected to histological and immunohistochemical testing. A communication between the cyst and the urethra was confirmed in four cases, but not in one case. Histological and immunohistochemical examinations of the epithelium lining indicated that its characteristics were identical to those of the prostatic utricle in all cases. The so-called Müllerian duct cyst exhibits features comparable to those previously described in the prostatic utricle. There is no evidence that these cystic lesions originate from the Müllerian duct remnant, at least in the epithelial lining. We suggest that they should be termed a prostatic utricular cyst or cystic dilation of the prostatic utricle, depending on whether an outlet to the urethra is absent or present, respectively.

Etiology of azoospermia in 100 consecutive nonvasectomized men

History was taken systematically for 100 azoospermic, nonvasectomized men referred consecutively to a Danish fertility clinic. The men were examined by ultrasound, and their blood samples were analyzed for karyotype, Y microdeletions, and cystic fibrosis transmembrane conductance regulator gene mutations. In 29% of patients, the condition could be explained by genetic abnormalities; in 22%, by diseases or external influence; and in 27%, by former cryptorchidism. The azoospermic condition remained unexplained in only 22%.

HISTOPATHOLOGICAL STUDY OF THE MÜLLERIAN DUCT REMNANT: CLARIFICATION OF DISEASE CATEGORIES AND TERMINOLOGY

We determined by histopathological studies whether there is an etiological difference in 2 distinct categories of müllerian duct remnant diseases. In addition, we clarified the nomenclature of these diseases. We recently performed radical prostatectomy in a patient with prostate cancer associated incidentally with a so-called müllerian duct cyst in the prostatic midline. The specimen was examined by pathological and immunohistochemical testing with special attention to the relationship of the cyst and utricle. We also investigated the histology of so-called enlarged prostatic utricles or vagina masculinus extirpated from patients with severe hypospadias or intersex disorder. The round cyst removed with the prostate seemed to arise from the verumontanum and it contained fluid with a high concentration of prostate specific antigen. Histological and immunohistochemical examination of its lining epithelium demonstrated that cyst characteristics were identical to those of the prostatic utricle. On the other hand, pouches extirpated from patients with pediatric problems were lined by squamous epithelium. The so-called müllerian duct cyst appeared to originate from the prostatic utricle, and so should be termed a utricular cyst or cystic utricle. Conversely the so-called enlarged prostatic utricle should be termed a vagina masculinus or male vagina. The term müllerian duct remnant, which would include these 2 abnormalities, may usefully be replaced by the term utricular abnormalities.

Surgical treatment of the Müllerian duct remnants

Background: Persistent Müllerian duct tissue in male individuals may result in an enlarged prostatic utricle (utricular cysts and utricle) or a Müllerian duct cysts, either distinctively or synonymously. In intersex patients Müllerian duct remnants (MDR) are an usual occurrence. Surgical excision is the definitive treatment of symptomatic remnants, as well as during the reconstruction of intersexual genitalia. Many approaches have been described. The authors review their experience in intersex patients. Methods: From 1986 to 1999, the authors treated 111 patients with intersex disorders. The records of 47 patients raised as boys with MDR were reviewed. Based on the symptoms and the size of the remnants, in 32 patients the structures were removed. In 13 patients extirpation was done by perineal approach, in 9 by transperitoneal approach, and in the remaining 9 patients the combined abdominal and perineal approach were undertaken. In one patient the large prostatic utricle was extirpated by a posterior sagittal pararectal approach. Perineal approach was mainly used in younger asymptomatic children, with the prostatic utricle disclosed incidentally during genitography because of intersex disorders. Operation was performed only in cases in which the prostatic utricle was observed by cystoscopy or identified by Fogarty balloon catheter introduction into the prostatic utricle. In older patients these structures were discovered frequently after failed urethroplasty, or after symptoms of urinary infection, urinary retention, or epididymitis. We elected to use the transperitoneal approach based on the extension of these structures into the pelvis. The average age of patients at the time of surgery was 8.6 years, with a range of 1 to 30 years. Results: There were no rectal or bladder injuries during surgery. An older patient had temporary impotence after abdomino-perineal extirpation. The lack of ejaculation, seen in 5 patients, was related to frequent intra-utricular termination of the vas deferens. Posterior sagittal pararectal approach certainly enabled complete exposure and exact visualization of all structures, with considerably decreased bleeding. If gonadal biopsy or gonadectomy were necessary, the transperitoneal approach could not be avoided. Conclusions: Surgical treatment of MDR in intersex patients varies according to the size of the utricle, and a double approach is often necessary. A high degree of success may be achieved with minimal morbidity. J Pediatr Surg 36:870-876. Copyright © 2001 by W.B. Saunders Company.