The posterior sagittal approach for the excision of a prostatic utricle cyst

Abstract

An 8-year-old boy presented with a prostate utricle cyst, measuring 14.7 x 27.8 cm on ultrasonogram ( Fig. 1).An indwelling catheter was placed in the bladder and the patient placed in a knee-chest position. The skin was incised sagittally in the midline from the tip of the coccyx downward up to the posterior anal perimeter. The underlying part of the external sphincter and muscle complex were cut in the midline with an electroknife under guidance of an electrostimulator. The rectum was exposed and pulled laterally to the right side using two rubber slings. The prostatic cyst was revealed and easily dissected free. It was elliptical and measured 8 x 16 cm after needle aspiration of its urine-like content (Fig. 2 ) . The fistulous communication of the cyst with the prostatic urethra was sutureligated and the cyst removed. Haemostasis was meticulous and draining of the operative field was deemed unnecessary. The rectum was released from the slings and replaced. The incised parts of the muscle complex Fig. 1. Transverse ultrasonogram. The bladder and a large fluid collection posterior to the bladder are demonstrated.and external sphincter were stitched and the skin incision closed. The post-operative course was normal. The catheter was retained until the sixth day and the patient was discharged on the eighth day after surgery, having achieved normal micturition. Histological studies of the cyst demonstrated a two-layer wall, consisting of fibrous tissue and transitional epithelium with foci of infection. CommentExcision of large or symptomatic utricle cysts is recommended. The rarity of the operation and anatomical difficulties in the operative field have led to a variety of surgical approaches, which are not free of complications. These approaches include the suprapubic transvesical or extravesical, transperitoneal, perineal, transurethral and posterior parasacral. The posterior sagittal approach has been widely used in the repair of congenital anorectal malformations [ 11, cloacal, urogenital sinus and postoperative faecal incontinence in children with anorectal 0 1995 British Journal of Urology 397

The Posterior Midsagittal Approach for the Surgical Excision of Intrapelvic Malignant Tumours

“…Surgery of pelvic floor lesions by PMA is performed either transanorectally or with sparing of the integrity of the rectum by lateral traction. Our previous experience from the excision of congenital rectovaginal fistula (6) and prostatic utricle cyst (5,7,9) by lateral traction of the rectum was used to excise the intrapelvic tumours, thus sparing our patients the necessity of a colostomy.…”

“…PMA has also been used with either lateral traction of the rectum or transanally (15) for the treatment in children with the following lesions: posttraumatic and postradiation fistulas (10,13), presacral masses (11,15), complications associated with surgery of Hirschsprungs disease (13), urogenital sinus (14), anterior sacral meningocele (16), high vaginal strictures (10), and Mullerian duct remnants (5,7,9). The same approach has been used for the excision of a presacral teratoma in an adult (1).…”

Giant prostatic utricle associated with proximal hypospadias: repair by mucosa divesting and muscular tunnel obliteration

“…Various techniques have been described, including open exposure by suprapubic, posterior midline transvesical; transperitoneal retrovesical; posterior midsagittal pararectal; and posterior sagittal transrectal approaches. Laparoscopic excision and endoscopic techniques have also been described [8][9][10][11][12][13][14][15][16][17][18][19]. Here, we describe a new approach to repair the giant prostatic utricle (pseudovagina) in 3 patients by divesting of utricle mucosa and obliteration of the muscular tunnel through the dorsal lithotomy position.…”

Origin of PSAM procedure in surgical oncology

“…Exceedingly different procedures are those described by Keramidas et al The authors mobilized the rectum with the use of a perirectal sling. They describe the procedure in the following way: “A sling is placed around the rectum permitting its lateral traction.” Moreover, as it is evident in fig.…”

“…They describe the procedure in the following way: “A sling is placed around the rectum permitting its lateral traction.” Moreover, as it is evident in fig. 1 and in technical description on prostatic utricle cyst excision, their technique is different from PSAM. The authors also write: “The anus remained in its normal position.…”