Symptomatic prostatic utricle: various approaches for treatment

Abstract

Background Pediatric presentations of a prostatic utricle have received only little attention. The incidence of symptomatic prostatic utricle has been reported but most cases are asymptomatic. The purpose of this study is to highlight the various clinical presentations and surgical approaches to treat a symptomatic prostatic utricle. Results This study includes a series of 7 cases over a period of 5 years. The diagnosis of prostatic was made on the basis of clinical presentations, ultrasonography, micturating cystourethrogram, and cystoscopy. Of the 7 patients, the newborn patient had antenatally detected abdominal cystic mass which presented with postnatal urinary retention, 5 patients had various urinary complaints, and 1 older child with disorder of sexual differentiation (DSD) had urinary incontinence. Depending upon the grade of prostatic utricle, treatment was done in the form of laparoscopic-assisted excision in 1, laparotomy and excision in 1, perineal excision in 2, and cystoscopic fulguration in 3 patients. Postoperative period was uneventful. All the patients were followed for a period of 1–2 years. Most of them were asymptomatic except one child who had recurrent episodes of epidydimo orchitis which was treated conservatively, and he was also asymptomatic at the end of 1 year. Five patients who had associated hypospadias were observed for one year for any urinary complaints before they underwent definitive repair for hypospadias. Conclusion Prostatic utricle is a vestigial remnant of müllerian duct most commonly associated with posterior hypospadias. High index of suspicion for prostatic utricle in cases with recurrent urinary complaints helps in timely detection and appropriate treatment can prevent further complications. Cystoscopy and micturating cytourethrogram remains the gold standard for diagnosis.