Severe lower urinary tract symptoms due to anteriorly located midline prostatic cyst arising from the bladder neck in a young male
case report
Keywords:
Cysts, Prostate, Prostatic diseases, Urinary bladder, Urinary bladder neck obstructionAbstract
CONTEXT: Prostatic cysts are uncommon. These cysts are usually asymptomatic and are diagnosed incidentally during ultrasonographic examination. On rare occasions, they may cause drastic symptoms. CASE REPORT: We report on a case of severely symptomatic anteriorly located prostatic cyst arising from the bladder neck in a 30-year-old man presenting with lower urinary tract symptoms, without clinical evidence of benign prostatic hyperplasia. Transrectal ultrasonography (TRUS), computed tomography (CT) and cystourethroscopy demonstrated a projecting prostatic cyst that occupied the bladder neck at the precise twelve o’clock position. It was acting as a ball-valve, such that it obstructed the bladder outlet. Transurethral unroofing of the cyst was performed and the patient’s obstructive symptoms were successfully resolved. Histopathological examination indicated a retention cyst. CONCLUSIONS: It should be borne in mind that midline prostate cysts can be a reason for bladder outlet obstruction in a young male. Such patients may have tremendous improvement in symptoms through transurethral unroofing of the cyst wall
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References
Galosi AB, Montironi R, Fabiani A, et al. Cystic lesions of the prostate gland: an ultrasound classification with pathological correlation. J Urol. 2009;181(2):647-57.
Dik P, Lock TM, Schrier BP, Zeijlemaker BY, Boon TA. Transurethral marsupialization of a medial prostatic cyst in patients with prostatitis- like symptoms. J Urol. 1996;155(4):1301-4.
Furuya S, Hisasue S, Kato H, Shimamura S. Novel insight for midline cyst formation in prostate: The involvement of decreased prenatal testosterone suggested by second-to-fourth digit ratio study. Int J Urol. 2015;22(11):1063-7.
Mayersak JS. Urogenital sinus-ejaculatory duct cyst: a case report with a proposed clinical classification and review of the literature. J Urol. 1989;142(5):1330-2.
Pillai RG, Al Naieb ZA. Successful Endoscopic Laser De-roofing of Simple Prostatic Cyst Causing Bladder Outlet Obstruction - A Case Study. Med Surg Urol. 2013;2(1). Available from: http:// www.omicsonline.org/successful-endoscopic-laser-de-roofing-of- simple-prostatic-cyst-causing-bladder-outlet-obstruction-a-case- study-2168-9857.1000107.pdf. Accessed in 2016 (Jul 5).
Nayyar R, Dogra PN. Anteriorly placed midline intraprostatic cyst. J Endourol. 2009;23(4):595-7.
Tambo M, Okegawa T, Nutahara K, Higashihara E. Prostatic cyst arising around the bladder neck-cause of bladder outlet obstruction: two case reports. Hinyokika Kiyo. 2007;53(6):401-4.
Issa MM, Kalish J, Petros JA. Clinical features and management of anterior intraurethral prostatic cyst. Urology. 1999;54(5):923.
Yildirim I, Kibar Y, Sümer F, et al. Intraurethral prostatic cyst: a rare cause of infravesical obstruction. Int Urol Nephrol. 2003;35(3):355-6.
Chang SG, Hwang IC, Lee JH, Park YK, Lim JW. Infravesical obstruction due to benign intraurethral prostatic cyst. J Korean Med Sci. 2003;18(1):125-6.
Lee JY, Kang DH, Park HY, et al. An anteriorly positioned midline prostatic cyst resulting in lower urinary tract symptoms. Int Neurourol J. 2010;14(2):125-9.
Diaz RR, Lee JY, Choi YD, Cho KS. Unroofed midline prostate cyst misled into a stricture with obliterative bladder neck contracture following a laser prostatectomy. Int Neurourol J. 2013;17(1):34-7.
Ishikawa M, Okabe H, Oya T, et al. Midline prostatic cysts in healthy men: incidence and transabdominal sonographic findings. AJR Am J Roentgenol. 2003;181(6):1669-72.
Nayyar R, Wadhwa P, Dogra PN. Midline intraprostatic cyst: An unusual cause of lower urinary tract symptoms. Indian J Urol. 2008;24(1):109-11.
Juárez Soto A, Ribè Subirà N, Manasia P, et al. Classification of cystic structures located at the midline of the prostate: our experience. Arch Ital Urol Androl. 2004;76(2):75-9.
Nghiem HT, Kellman GM, Sandberg SA, Craig BM. Cystic lesions of the prostate. Radiographics. 1990;10(4):635-50.
Furuya R, Furuya S, Kato H, et al. New classification of midline cysts of the prostate in adults via a transrectal ultrasonography- guided opacification and dye-injection study. BJU Int. 2008;102(4):475-8.
Stricker HJ, Kunin JR, Faerber GJ. Congenital prostatic cyst causing ejaculatory duct obstruction: management by transrectal cyst aspiration. J Urol. 1993;149(5):1141-3.
Saito S. Transrectal ultrasound-guided puncture, drainage, and minocycline hydrochloride sclerotherapy for the symptomatic prostatic cyst. J Endourol. 2002;16(9):693-5.
Zhang H, Qi F, Wang J, Chen M, Li Z, Zu X. Midline Prostatic Cysts Presenting with Chronic Prostatitis or Secondary Infertility and Minimally Invasive Treatment: Endoscopic or Laparoscopic Approach? Surgical Science. 2011;2:285-9. Available from: http://file.scirp.org/pdf/SS20110500013_35824482.pdf. Accessed in 2016 (Jun 8).
