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

Abstract

Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has little effect on the large cysts and cysts lying deeply, in contrast with the laparoscopic approach. Therefore, the selection of minimally invasive therapeutic approaches is important. The aim of this study is to describe our experience in the diagnosis and selection of minimally invasive treatment for midline prostatic cyst. Methods: 15 cases of midline prostatic cyst were studied.10 cases presented with prostatitis-like symptoms, 1 with dysuria and acute urinary retention, 3 with secondary infertility and the rest 1 with hemospermia. 6 patients presented with small cysts (≤2 cm × 2 cm) close to urethra and underwent transurethral unroofing. The other 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate received the laparoscopic excision. Results: The average duration of transurethral unroofing and laparoscopic excision was 39 mins and 118 mins respectively, whereas the average time of hospitalization was 2.7 days and 4.5 days respectively. After a follow-up of 21 months, all cases were treated successfully without complications and recurrence. Their prostatitis-like symptoms disappeared, and the three patients presented with secondary infertility achieved conception within one year after the operation. Conclusions: A midline prostatic cyst can present with chronic prostatitis-like symptoms and secondary infertility. It can be cured by minimally invasive treatments, but these procedures should be carefully selected according to the size and location of the cyst.

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

“…However, transurethral techniques have shown no recurrence of MPCs during follow-up. Zhang et al [18] also recommended transurethral unroofing of small prostatic cysts that are close to the urethra or bladder cavity because of its simplicity, outcomes, low complication rate and short recovery period.…”

A case report of an uncommon large size of prostatic cyst

“…Prostatic cyst is a rare disease with uncertain origin [1][2][3][4], which needs to be differentiated from prostatic neoplastic masses, prostatic non neoplastic masses, periprostatic neoplastic masses, periprostatic neoplastic masses and cyst of seminal vesicle. Most of prostatic cysts are small and located laterally without spermatozoa [5][6][7][8].…”

Severe lower urinary tract symptoms due to anteriorly located midline prostatic cyst arising from the bladder neck in a young male: case report

“…14 An analysis on 34 patients with symptomatic prostatic cysts by Tambo et al 7 revealed that 40% of the patients suffered from obstructive urinary symptoms, 33% from urinary retention, 9% from urodynia and 6% from infertility. 20 also recommended transurethral unroofing of small prostatic cysts (< 2 cm x 2 cm) that are close to the bladder cavity or urethra, because of the simplicity of the technique, the low risk of complications and the shorter convalescence period.…”