Infravesical Obstruction Due to Benign Intraurethral Prostatic Cyst

Abstract

INTRODUCTIONThe prevalence of prostatic cysts detected by transrectal ultrasound is 5% (1). Most prostatic cysts are asymptomatic and are located in the medial portion of the prostate. Midline cysts are located posteriorly at the prostatic floor, originating from posterior structures such as the utricle, the ejaculatory duct, or an intraprostatic ectopic ureter. We report a patient with a unique intraurethral prostatic cyst that originated from the left side of the lateral lobe of the prostate (2 o' clock direction) and discuss the clinical presentation, transrectal ultrasonographic/cystoscopic features, and management. To our knowledge, this is the second documentation of such an entity in published reports. CASE REPORTA healthy 42-yr-old man presented with a 10-yr history of progressive, infravesical obstructive symptoms that did not respond to medical therapy such as alpha-blocker. The International Prostate Symptom Score (IPSS) was 18, and the quality of life (QOL) score was 5. Digital rectal examination revealed a minimally enlarged prostate without palpable nodules. Uroflowmetry showed a peak flow rate (Qmax) of 7 mL/sec (200 mL voided volume) and a postvoid residual urine volume of 150 mL. The cyst (20×15 mm) was anechoic and appeared to be obstructing the bladder neck on the transrectal ultrasonography (Fig. 1A) A large, fluid-filled cyst with a smooth surface was located at the bladder neck on cystoscopy (Fig. 1B). The cystic lesion had a single short stalk that originated from the left lateral lobe of the prostate. The cyst appeared to be obstructing the bladder outlet by a ball-valve action. There was no lateral lobe prostatic hypertrophy. The bladder was moderately trabeculated. Both ureteral orifices were normal and distant from the cyst. The prostate measured 35 mL. Transurethral resection of the cyst at base of the cyst was performed. The histopathologic findings were consistent with a benign cyst lined with columnar epithelium and proliferative urothelial lining (Fig. 2). We performed a follow-up check at 3 months after surgery. Postoperatively, Qmax increased to 15 mL/sec without residual urine. There was neither erectile dysfunction nor retrograde ejaculation. DISCUSSIONProstatic cysts are common, with a 5% incidence in a male population (1).A cyst in the midline of the prostate gland is a mullerian duct cyst or a utricular cyst. These terms tend to be used interchangeably but recent studies suggest different embryological origins. The mullerian duct cyst is of mesodermal origin, not communicating with the prostatic urethra or seminal vesicles, and it never contains sperm. In the utricular cyst, which is of endodermal origin, the ejaculatory ducts can be localized in the lateral wall of the cyst, communication with the prostatic urethra is common and sperm may be present (2, 3). J Korean Med Sci 2003; 18: 125-6 ISSN 1011-8934 Copyright � The Korean Academy of Medical Sciences 125 Infravesical Obstruction Due to Benign Intraurethral Prostatic CystWe report a case of symptomatic intraurethra...

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

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