New classification of midline cysts of the prostate in adults via a transrectal ultrasonography‐guided opacification and dye‐injection study

Abstract

OBJECTIVES To reclassify midline cysts (MLCs) of the prostate according using the results from transrectal ultrasonography (TRUS)‐guided opacification and dye injection. PATIENTS AND METHODS Eighty‐six patients (mean age 60.9 years) who had MLCs detected in the pelvis by TRUS were investigated. In all patients the size of the MLC was measured and they had transperineal aspiration under TRUS guidance. After aspiration of the MLC a mixture of water‐soluble contrast medium and indigo carmine dye was injected to check for communication with the urethra or seminal tract by endoscopic and pelvic X‐ray examination. RESULTS We classified MLCs into four categories: (i) type 1 (nine cases), MLC with no communication into the urethra (traditional prostatic utricle cyst); (ii) type 2a (60 cases), MLC with communication into the urethra (cystic dilatation of the prostatic utricle, CDU); (iii) type 2b (14 cases), CDU which communicated with the seminal tract; (iv) type 3 (three cases), cystic dilation of the ejaculatory duct. The location, shape and volume of the MLC, and the prostate‐specific antigen level of MLC fluid, did not influence the classification. CONCLUSIONS The most common type of MLC was CDU. A new classification that depends on the communication with the urethra or seminal tract is proposed.

Ectopic Opening of Cystic Dilatation of the Ejaculatory Duct Into Enlarged Prostatic Utricle

“…Either cystic dilatation of the ED or EPU can cause hematospermia and other ejaculatory disturbances, testicular or perineum pain, urinary obstruction, lower urinary tract infection, and male infertility (Coppens et al, 2002). To date, cases of ectopic opening of the ED into EPU have been reported by several researchers (Nakachi et al, 1987; Furuya et al, 2008); however, cases of cystic dilatation of the ED communicating with EPU have not been reported previously. In this paper, we report the first case of ectopic opening cystic dilatation of the ED into EPU.…”

Natural history of hematospermia in 189 Japanese men

“…These lesions extended from the posterior side of the verumontanum toward the retrovesical trigone, passing between the posterior aspect of the prostate and seminal vesicle. MLCs were classified into the three types according to the previously reported criteria . TRUS‐guided seminal vesicle puncture and opacification of the MLC of the prostate were carried out for 23 patients to confirm communication between the MLC and ejaculatory duct.…”

“…MLCs were classified into the three types according to the previously reported criteria. 16 TRUSguided seminal vesicle puncture and opacification of the MLC of the prostate were carried out for 23 patients to confirm communication between the MLC and ejaculatory duct.…”

Midline Prostatic Cysts Presenting with Chronic Prostatitis or Secondary Infertility and Minimally Invasive Treatment: Endoscopic or Laparoscopic Approach?

“…Even so, sometimes conventional terminology indicating each midline prostatic cyst is not adequate to differentiate their subtle variations. Recently, Furuya et al [13] proposed a new classification of midline prostatic cyst: 1) type 1, cyst with no communication into the urethra (traditional prostatic utricle cyst); 2) type 2a, cyst with communication into the urethra (cystic dilatation of the prostatic utricle, CDU); 3) type 2b, CDU which communicated with the seminal tract; 4) type 3 (three cases), cystic dilation of the ejaculatory duct. These may help to classify various kinds of midline cysts of the prostate.…”