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

Hui-hui Zhang, Fan Qi, Jun Wang, Min-feng Chen, Zhuo Li, Xiong-bing Zu

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DOI: 10.4236/ss.2011.25061                

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.

Keywords

Midline Prostatic Cyst, Chronic Prostatitis, Secondary Infertility, Minimally Invasive Treatment, Transurethral Cyst Unroofing, Laparoscopy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Ishikawa, H.Okabe and T. Oya, “Midline Prostatic Cyst in Healthy Men: Incidence and Transabdominal Sonographic Findings,” American Journal of Roentge-nology, Vol. 181, No. 6, 2003, pp. 1669-1672.
[2]	P. Dik, T. M. Lock and B. P. Schrier, “Transurethral Marsupialization of a Medial Prostatic Cyst in Patients with Prostatitis-Like Symptoms,” Journal of Urology, Vol. 155, No. 4, 1996, pp. 1301-1304. doi:10.1016/S0022-5347(01)66251-7
[3]	J. S. Mayersak, “Urogenital Sinus-Ejaculatory Duct Cyst: a Case Report with a Proposed Clinical Classification and Review of the Literature,” Journal of Urology, Vol. 142, No. 5, 1989, pp. 1330-1332.
[4]	S. W. Warmann, M. Vogel and M. Wehrmann, “Giant Mullerian Duct Cyst with Malignant Transformation in 15-Year-Old Boy,” Urology, Vol. 67, No. 2, 2006, pp. 424-426. doi:10.1016/j.urology.2005.09.009
[5]	L. Coppens, P. Bonnet and R. Andrianne, “Adult Mulle-rian Duct or Utricle Cyst:clinical Significance and The-rapeutic Management of 65 Cases,” Journal of Urology, Vol. 167, No. 4, 2002, pp. 1740-1744. doi:10.1016/S0022-5347(05)65190-7
[6]	C. K. Yeung, J. D. Sihoe and Y. H. Tam, “Laparoscopic Excision of Prostatic Utricles in Children,” Brithish Journal of Urology International, Vol. 87, No. 6, 2001, pp. 505-508.
[7]	I. E. Willetts, J. P. Roberts and A. E. MacKinnon, “La-paroscopic Excision of a Prostatic Utricle in a Child,” Pediatric Surgery International, Vol. 19, No. 7, 2003, pp. 557-558. doi:10.1007/s00383-003-0993-6
[8]	S. Curran, O. Akin and A. M. Agildere, “Endorectal MRI of Prostatic and Periprostatic Cystic Lesions and Their Mimics,” American Journal of Roentgenology, Vol.188, No. 5, 2007, pp. 1373-1379. doi:10.2214/AJR.06.0759
[9]	T. D. Schuhrke and G. W. Kaplan, “Prostatic Utricle Cysts (Mullerian Duct Cysts),” Journal of Urology, Vol. 119, No. 6, 1978, pp. 765-767.
[10]	S. G. Chang, I. C. Hwang and J. H. Lee, “Infravesical Obstruction due to Benign Intraurethral Prostatic Cyst,” Journal of Korean Medical Science, Vol. 119, No. 6, 2003, pp. 125-126.
[11]	M. Barzilai and Y. Ginesin, “A Mullerian Prostatic Cyst Protruding into the Base of the Urinary Bladder,” Urolo-gia Internationalis, Vol. 60, No. 3, 1998, pp. 194-196. doi:10.1159/000030251
[12]	R. Yasumoto, M. Kawano and T. Tsujino, “Is a Cystic Lesion in the Midline of the Prostate a Mullerian Duct Cyst?” European Urology, Vol. 31, No. 2, 1997, pp. 187- 189.
[13]	R. Furuya, S. Furuya and H. Kato, “New Classification of Midline Cysts of the Prostate in Adults via a Transrectal Ultrasonography-Guided Opacification and Dye-Injection Study,” Brithish Journal of Urology International, Vol. 102, No. 4, 2008, pp. 475-478.
[14]	Y. N. Reddy and C. C. Winter, “Cyst of the Seminal Ve-sicle: A Case Report and Review of the Literature,” Journal of Urology, Vol. 108, No. 1, 1972, pp. 134-135.
[15]	R. Anding, F. Steinbach and T. M. Bernhardt, “Urology Treatment of Large Prostatic Cyst with Retropubic Inser-tion of a Fat Tissue Flap,” Journal of Urology, Vol. 164, No. 2, 2000, pp. 454-455. doi:10.1016/S0022-5347(05)67390-9
[16]	E. B. Cornel, G. R. Dohle and E. J. Meuleman, “Transu-rethral Deroofing of Midline Prostatic Cyst for Subfertile Men,” Human Reproduction, Vol. 14, No. 9, 1999, pp. 2297-2300. doi:10.1093/humrep/14.9.2297
[17]	E. M. McDougall, R. V. Clayman and W. T. Bowles, “Laparoscopic Excision of Müllerian Duct Remnant,” Journal of Urology, Vol. 152, No. 2, 1972, pp. 482-484.
[18]	J. H. Luo, W. Chen and J. J. Sun, “Laparoscopic Man-agement of Müllerian Duct Remnants: 4 Cases Report and Review of the Literature,” Journal of Andrology, Vol. 29, No. 6, 2008, pp. 638-642. doi:10.2164/jandrol.108.005496