An Anteriorly Positioned Midline Prostatic Cyst Resulting in Lower Urinary Tract Symptoms

Abstract

Most prostatic cysts are not symptomatic and are found incidentally. There have been some reports of prostatic cysts presenting as an infravesical obstruction. Our case is the second published report of an anteriorly positioned midline prostatic cyst of the bladder neck. The prostatic cyst in a 41-year-old man presenting with lower urinary tract symptoms was located in the anterior and midline area of the prostate and was protruding into the bladder neck at the precise twelve o'clock position. The cyst obstructed the bladder neck by acting like a checking valve. Transurethral resection of the cyst was performed, and the obstructive symptoms successfully improved. In recent years, the increasing use of transrectal ultrasound (TRUS) and computed tomography (CT) scans have resulted in the discovery of incidental prostatic cysts. Prostatic cysts are observed in 0.5% to 7.9% of patients and are classified into six distinct types [1]. Most prostatic cysts are asymptomatic and are located posteriorly. Symptomatic prostatic cysts may be confused with benign prostatic hyperplasia (BPH) or neuropathic bladder when they present with lower urinary tract symptoms (LUTS) [2]. Midline prostatic cysts are less common and are mostly located posteriorly. Treatment options for symptomatic midline prostatic cysts include transrectal aspiration, transurethral marsupialization, and open surgery [3]. Here we report on a single case of a midline prostatic cyst of the bladder neck in the precise twelve o'clock position. The prostatic cyst was located anteriorly and acted like a checking valve during urination. To date, there have been fewer than five published reports of cases of symptomatic midline prostatic cysts located anteriorly [3][4][5]. Some cases of infravesical midline prostatic cysts have been reported [6,7]. To our knowledge, this is the second published report of an anteriorly positioned midline prostatic cyst of the bladder neck [7] and the first case report of a prostatic cyst in Korea. CaseA 41-year-old man presented with LUTS, including dysuria, frequency, weak urine stream, and a sensation of residual urine that had appeared two weeks before. He had no previous medical problems and had been healthy. His International Prostate Symptom Score (IPSS) was 20, and his quality of life (QoL) score was 4. Uroflowmetry showed that the peak flow rate was 9 mL/s (136 mL voided volume) and the volume of residual urine was more than 200 mL. A digital rectal examination revealed a normal pros-

Prostatic cyst with bladder outlet obstruction symptoms. case report

“…The patient was treated with transurethral resection of the cyst, and the obstructive symptoms successfully improved. 8 Tambo and Joo-Yong reported cases of prostatic cysts arising around the bladder neck similar to our case, 3, 8 but the localization of the cyst of our case was posterior. The retention cysts of the prostate are resulting from the obstruction of the glandular acinis causing its dilation.…”

“…In order to minimize the risk of complications is recommended the use of lower-Fr endoscopic instrument with minimal trauma to the bladder neck and urethra. 1,3,8,9,10,11 The malignancy natures of the prostatic cysts are less frequent. The lower male genitourinary tract is an extremely rare location for adenoid cystic carcinoma.…”

New technique for the management of anteriorly located midline prostatic cysts causing severe lower urinary tract symptoms: Case report and literature review

“…Cystic lesions in the lower male genitourinary tract are uncommon and are typically benign. In some cases, they may be associated with various genitourinary abnormalities and symptoms, such as chronic pelvic pain syndrome, postvoiding incontinence, urinary tract infection, obstructive and/or irritative voiding symptoms, recurrent epididymitis, prostatitis, hematospermia, ejaculatory pain, low semen volume or even infertility in some cases [6,[10], [11], [12]].…”

Unroofed Midline Prostate Cyst Misled Into a Stricture With Obliterative Bladder Neck Contracture Following a Laser Prostatectomy

“…So far, in published reports, the total number of cases of symptomatic midline prostatic cysts located anteriorly is fewer than five [3]. Prostatic cysts are observed in 0.5% to 7.9% of patients and are classified into six distinct types including: 1) isolated medial cysts, 2) cysts of the ejaculatory duct, 3) simple or multiple cysts of the parenchyma, 4) complicated cysts (infectious or hemorrhagic), 5) cystic tumors, and 6) cysts secondary to parasitic disease [4].…”