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

Abstract

We report on a case of a 67-year-old man who presented with persistent lower urinary tract symptoms following a potassium titanyl phosphate laser photoselective vaporization of prostate. Upon further diagnostic examinations were performed, he was noted to have an obliterative bladder neck contracture with an incidental, misleading, and rare presence of an unroofed midline anterior prostatic cyst presenting as a stricture. As we were presented with this case, it was imperative to address these complications of bladder neck contracture and incompletely ablated prostatic cyst. This report brings to light underestimated complicating factors in the urinary tract, and the diagnostic and therapeutic interventions we had undertaken to rectify the identified complications and improve patien's quality of life. The patient underwent internal urethrotomy, resection of prostatic cyst wall and transurethral resection of the prostate directed to improve his quality of life and prevent urinary retention.

Urinary retention in adult hypospadias patient resolved by unroofing of a mildly enlarged prostatic utricle

“…reported a case of Müllerian duct remnants, in which transurethral resection of the prostatic cyst wall along with resection of the prostate improved the quality of life by preventing urinary retention. The authors concluded that the cyst had obstructed the bladder outlet with a ball‐valve mechanism 8 . In the present case, urinary retention did not seem to be caused by a ball‐valve mechanism.…”

“…Laparoscopic or robotic excision affords minimally invasive access to the retrovesical space 9,10 . However, such resection of the utricle should only be partial and avoid destruction of the seminal tract, and its indication is limited to larger utricles 8 …”

Anteriorly Placed Midline Intraprostatic Cyst Resulting in Bothersome Lower Urinary Tract Symptoms: A Case Report

“…Anteriorly placed MPCs presenting with LUTS are extremely rare since only about 10 reports have ever been published [ 3 , 4 , 6 - 12 ]. Some cases have been reported to arise at the level of prostatic urethra, causing bladder outlet obstruction and being managed conservatively with antegrade ejaculation preservation [ 9 - 12 ]. What makes the present case further interesting is the unusual location of the MPC at the anterior aspect of the bladder neck region, raising both diagnostic and therapeutic challenges.…”

“…Anteriorly placed MPCs presenting with LUTS are extremely rare since only about 10 reports have ever been published [3,4,[6][7][8][9][10][11][12]. Some cases have been reported to arise at the level of prostatic urethra, causing bladder outlet obstruction and being managed conservatively with antegrade ejaculation preservation [9][10][11][12].…”

“…Consequently, transurethral marsupialization may be a feasible and effective treatment option for small anteriorly located MPCs (2 cm x 2 cm) [4,7], as in this case. However, it is important to distinguish MPCs originating in the bladder neck region from infravesical cysts, as the latter may be marsupialized into the urethra with a lower risk of causing retrograde ejaculation [9][10][11][12].…”