Accidental cystectomy during laparoscopic excision of prostatic utricle cyst - a rare complication

Abstract

Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treatment. Surgical excision is the treatment of choice, but is challenging due to close proximity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally removed during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.

Laparoscopic treatment of paraprostatic cyst in two dogs – complete resection, and partial resection with omentalization: a case report

“…In humans, cases of prostatic utricle cysts (congenital anomalies derived from the Müllerian duct remnant) treated with laparoscopic excision without omentalization have been reported ( 19–23 ). Sixteen patients showed no complications or recurrence, but there was a disastrous case of accidental cystectomy with bilateral ureteral injury ( 24 ). Given the routine use of vessel-sealing devices in laparoscopic surgery, it is critical to make great efforts to avoid tissue trauma.…”

Symptomatic prostatic utricle: various approaches for treatment

“…All these approaches require extensive dissection, often requiring two stages and result in poor exposure. Most common complication are incontinence, infections, and impotence secondary to injury to pelvic nerves [6,7,12,15].…”

“…The pathological presentations of PU are variable [3]. Association of PU with severe hypospadias and intersex is high as 14-27.5% [1,4,5], approximately 11-14% are associated with proximal hypospadias [6,7]. Thus, the literature shows that the incidence of PU increases with the severity of hypospadias.…”

“…Further, surgical management of PU remains challenging due to the close proximity of the lesions to ejaculatory ducts, vas deference, pelvic nerves, ureters, and rectum [1]. The complications associated with surgical approaches include urethral injury, rectal injury, infertility, impotence, and fecal incontinence [7].…”