The prostatic utricle: An under-recognized condition resulting in significant morbidity in boys with both hypospadias and normal external genitalia

Hester, Austin G.; Kogan, Stanley J.

doi:10.1016/j.jpurol.2017.01.019

Cited by 22 publications

(18 citation statements)

References 14 publications

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“…The diagnosis is suspected when there is clinical manifestation and the mass is felt on the digital rectal examination. A pelvic ultrasound, a transrectal ultrasound or a perineal ultrasound can show cavity filled with fluid and its relationship with adjacent anatomical structures such as the prostate and urethra [23]. In VCUG or RUG, the utricles may have different sizes, showing an opacified cystic structure posterior to the prostatic urethra.…”

Section: Discussionmentioning

confidence: 99%

Prostatic utricles without external genital anomalies in children: our experience, literature review, and pooling analysis

Liu

Zhang

et al. 2019

BMC Urol

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Background It has been recognized that the incidence of prostatic utricle in boys is increasing and is closely associated with diseases such as hypospadias. However, the clinical features of prostatic utricle with normal external genitalia have received little attention. Methods Based on this, a series of 22 male children with prostatic utricles has been compiled by adding our 3 patients to 19 cases reported. All children enrolled had normal external genitalia. Clinical data of the case was reviewed. Results Urinary tract infection, purulent urethral discharge and pyuria were the most common presenting chief complaint (41%), irritative lower urinary tract symptoms were present in 17% of cases, obstructive lower urinary tract symptoms were noted in 14%. Urinary retention has been reported in 18% and epididymitis has been reported in 14%. Relatively rare clinical symptoms are abdominal pain, hematuria, and hematospermia. A case of calculus formation and a case of neoplasia within the prostatic utricle has been reported. A cystic mass found by digital rectal examination is the most common presenting sign. A utricular lesion posterior to the bladder was revealed by imaging examination. Unilateral renal agenesis was associated in 32% of reports. Non-surgical approach was chosen in 3 cases, transrectal ultrasonography guided aspiration has been reported in 1 case. Endoscopic techniques were used in 3 cases. Open excision was used in 11 cases. The laparoscopic excision was chosen in 3 cases and Robot-assisted laparoscopy was reported in 1 case. Symptoms and signs disappeared after treatment in all children, and no recurrence occurred during follow-up. Conclusions Prostate utricles without external genital anomalies are rarely reported in children, and are easily missed and misdiagnosed, often accompanied by recurrent urinary tract infections, lower urinary tract symptoms, epididymitis, dysuria and other symptoms. Imaging studies can confirm the diagnosis. Symptomatic and large utricles should be actively treated. The treatment program should be based on the age, clinical symptoms, and size and location of the utricle.

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Section: Discussionmentioning

confidence: 99%

Prostatic utricles without external genital anomalies in children: our experience, literature review, and pooling analysis

Liu

Zhang

et al. 2019

BMC Urol

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“…[3][4][5] Because of the difficulties associated with open surgical approaches, laparoscopic management was proposed in 2001 by Yeung et al 3 Subsequently, several case reports have described some technical differences, such as cystoscopic guidance, bladder stitch, and use of endoclip or endoloop for ligation of PUs. 1,2,10,11 Laparoscopic excision of PUs provides good exposure, improved wound cosmesis, complete excision, and a lower complication rate. 2,3,6 Jia et al 6 reported significantly shorter hospitalization, lower estimated blood loss, and shorter surgical duration using the laparoscopic approach, as compared with open procedures.…”

Section: Discussionmentioning

confidence: 99%

Cystoscopy-Guided Laparoscopic Excision of Prostatic Utricle: Report of a Case

Boybeyi

Demirbilek

Soyer

2020

European J Pediatr Surg Rep

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Prostatic utricle (PU) is incomplete regression of Müllerian duct and may cause recurrent urinary tract infections (UTIs), stone formation, postvoid dribbling, and recurrent epididymitis. Although surgical excision is recommended to avoid complications, surgical access to PU has been challenging. Cystoscopy-guided laparoscopic management of PU in a 3-year-old boy is reported to discuss use of other endoscopic aids in the surgical treatment of PU. He was admitted with disordered sexual development with karyotype of 47,XYY/46,XY and has been experiencing recurrent UTIs. Voiding cystourethrogram (VCU) demonstrated large PU (IKOMA II). Cystoscopy was performed confirming PU and the cystoscope was left in situ to aid laparoscopic exploration after bladder was emptied. A 5-mm umbilical port and two 5-mm ports in both lower quadrants were inserted. The peritoneum was dissected behind bladder. The cystoscope in PU was used as guidance in identification and dissection of PU. The vas deferens was identified and could be secured. The neck of PU was ligated with surgiloop. PU was retrieved from umbilical port. Postoperative VCU revealed normal posterior urethra. He has been free of UTIs for the last 6 months. Laparoscopy is safe and feasible alternative in surgical management of PU, by providing good visual exposure, easy dissection in deep pelvis, and improved cosmesis. The cystoscopic guidance is an important aid in identification and dissection of PU.

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“…1). Although most of them are symptomatic, asymptomatic cases are also reported [2]. The pathological presentations of PU are variable [3].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the literature shows that the incidence of PU increases with the severity of hypospadias. About 29% of children may present with clinical symptoms in childhood due to increase in the size of PU, recurrent UTI [8], stones, epidydimo orchitis, dysuria and psedoincontinence due to trapping of urine in the pouch [2,9], cystoscopy, micturating cystourethrogram (MCUG), and ultrasonography are diagnostic [10,11].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic prostatic utricle: various approaches for treatment

et al. 2020

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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.

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The prostatic utricle: An under-recognized condition resulting in significant morbidity in boys with both hypospadias and normal external genitalia

Cited by 22 publications

References 14 publications

Prostatic utricles without external genital anomalies in children: our experience, literature review, and pooling analysis

Prostatic utricles without external genital anomalies in children: our experience, literature review, and pooling analysis

Cystoscopy-Guided Laparoscopic Excision of Prostatic Utricle: Report of a Case

Symptomatic prostatic utricle: various approaches for treatment

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