Management of müllerian duct remnants in the male patient

We evaluated 36 patients for müllerian duct remnants that were manifest in several forms. The most common type was an enlarged prostatic utricle communicating with the urethra in 22 younger patients, which was associated with hypospadias or intersex disorders in more than 90 per cent of the cases. A cystic müllerian duct remnant was the other configuration noted in 14 older patients who had normal external genitalia and often presented with a rectal mass. The diagnostic evaluation consists of voiding cystourethrography, retrograde urethrography and cystoscopy. Other useful imaging techniques are ultrasonography and computerized tomography. Careful delineation of the anatomy of the lower urinary and genital tracts will help to plan surgical therapy. Suprapubic excision was the most frequent operation and it was successful in all 18 patients in whom it was performed.

Neoseminal vesicle created from retained mullerian duct to preserve the vas in male infants

Patients with retained mullerian ducts who have a predominantly male phenotype must undergo removal of the mullerian structure in addition to preservation of male structures. Often the vas conjoins with the vaginal wall. Whereas formerly we divided the vas from the mullerian structures, we now attempt to preserve the vas to maintain as much testicular function as possible by creation of a neoseminal vesicle. This procedure can be done separately or can accompany hypospadias reconstruction.

Pregnancy outcome after metroplasty in women with müllerian anomalies

Pregnancy outcomes in 22 consecutively operated women with Müllerian anomalies are described. In 16 women the indication for metroplasty was two or more spontaneous abortions and/or premature deliveries. The frequency of successful pregnancies increased from 5% before to 76% after operation. In 6 women metroplasty was performed on account of infertility. It is argued that infertility rarely constitutes an indication for metroplasty, and only when concurrent causes of infertility have been excluded. Several of the postoperative pregnancies and deliveries presented serious complications. Cesarean section is therefore recommended in some deliveries after metroplasty.

[Torsion of gonadal hydatids in childhood]

On the basis of 34 cases of the torsion of the appendix testis, the authors describe the clinical symptoms and the differential diagnosis compared with other cases of the acute scrotum. The diagnostic value of the "button symptom", of Doppler sonography, scintigraphy, as well as the indication of early surgical intervention is discussed.

Mullerian duct cyst (utricular cyst): treatment with the transvesical, transtrigonal approach

The diagnosis of mullerian duct or utricular cyst should be considered in a child with urinary difficulties and a palpable midline, anterior rectal mass. Endoscopic cannulation of the cyst has been found to be the most useful diagnostic test. Infection should be treated with the appropriate antibiotics before definitive treatment. Surgical excision offers the best result. The transperitoneal and posterior parasacral approaches have been described but we favour the transvesical, transtrigonal approach which we find highly satisfactory. The risk of malignancy at a later age is an added indication for surgery.

Complications of vaginal atresia in association with a duplicated mullerian duct

A mullerian duct duplication with a vaginal atresia can present as a painful abdominal mass in a female caused by a hematometrocolpos and a hemosalpinx. This set of signs and symptoms, if caused by an associated unilateral vaginal atresia, may be found in a female with normal menstrual periods, and (1) can be misdiagnosed with often tragic consequences caused by unnecessary salpingectomy, or even hysterectomy; (2) can be successfully treated by creating an adequate channel for drainage through the area of vaginal atresia; and (3) has a high association with unilateral renal agenesis. Because of this last point, recognition of either a mullerian duct duplication or unilateral renal agenesis should prompt an investigation for the other abnormality.

[Mullerian duct cysts. A case report]

Muellerian duct cysts are rarely occurring, cystic lesions in the true pelvis, differing in size, derived from or continuous with the prostate and seminal vesicles. They mostly manifest themselves between the ages of 30-40 years. The most common symptoms are related to irritability and obstruction of the lower urinary tract as well as the rectum. Therapy is troublesome because of incomplete resection resulting in frequent recurrences and iatrogenic damages including incontinence and impotence. One case of Muellerian duct cyst with a history of several operations is reported.

Müllerian remnant causing bladder outlet obstruction

Less than one-third of patients with persistent müllerian duct remnants develop bladder outlet obstructive symptoms. We report on two cases of bladder outlet obstruction caused by massive dilatation of persistent müllerian duct remnants. Such structures should be suspected when outlet obstructive symptoms occur in patients with hypospadias and/or undescended gonads. Care should be taken to identify possible urethral obstruction distal to the prostatic urethra as a cause of gross enlargement of persistent müllerian duct remnants.

[A case of recurrent cyst of Müllerian duct]

A case of recurrent cyst of Müllerian duct is reported. The patient had complained of dysuria and underwent resection of Müllerian duct cyst in May, 1977. Five years later (in July, 1982) at 50 years old, he again visited our clinic with the complaint of urinary retention and perineal mass formation. Recurrent multilocular cyst of Müllerian duct was diagnosed by CT and transrectal ultrasonotomography. Transabdominal extirpation of Müllerian duct cyst, combined with perineal approach, was performed under general anesthesia. The cyst was multilobular, 165 g in weight and 17 X 6.5 X 4 cm in size. Transparent yellow fluid of the cyst was about 2,000 ml in volume. Histologically it was fibroadenomatous cyst. The differential diagnosis and surgical treatment of Müllerian duct cyst is discussed.

Müllerian duct remnants in the male

Persistent remnants of the caudal Müllerian duct in the male may occasionally give rise to symptoms and pose a problem of management. We describe 13 cases which have been seen over a 24-year period. In 4 cases the remnant took the form of a cyst, whilst the other 9 had tubular utricular structures. Not all had an associated maldevelopment of the genitalia and there was no relationship between the size of a tubular remnant and the degree of genital abnormality. Infection generally appeared to be related to the presence of obstruction to the free drainage of the contents of the remnant, and epididymitis occurred where free reflux into the vasa was present. Apparent incontinence was sometimes the result of urine pooling in the utricular pouch. The radiological demonstration of these structures was not always easy and in our experience voiding cystourethrography was the best means of achieving a diagnosis. Surgical excision of these structures can be difficult, and if they do not produce symptoms they should be left alone.

Surgical approach to large müllerian duct cysts

Failure of the müllerian duct system to undergo complete involution in the male embryo may result in cystic dilation of these remnants. When these cysts attain great size, they may become paopable abdominally and cause voiding symptoms. A case is presented and the operative approach described. A suprapubic approach affords the best exposure for the complete removal of large müllerian duct cysts.

Persistent Müllerian duct structures in cryptorchid male infants: surgical dilemmas

Persistent Müllerian duct structures were found in 3 male cryptorchid infants aged 10--12 mo, during correction of a unilateral inguinal hernia. Division of the vas degerens, hysterectomy and scrotal orchidopexy were carried out. The authors believe that in subjects with a persistent müllerian duct syndrome, surgical placement of the testes into the scrotum should be performed. This is, as a rule, not possible without damage to the vas deferens which runs parallel and adheres closely to the surface of the uterus.

Inguinal hernia containing a paramesonephric (Müllerian) duct in an adult male. A case report

This article describes the extremely rare contents of a right indirect inguinal hernial sac in an adult male, namely a paramesonephric duct. Radiological investigation at operation by means of 'salpingography' demonstrated the connection of this 'uterus' with the prostatic utricle. 'Salpingohysterectomy' was performed. Sex typing of the patient determined him to be a male. His family history revealed siblings with intersex features; the prenatal determination of sexual identity is discussed and reference made to the fate of the mesonephric (Wolffian) and paramesonephric (Müllerian) remnant.

Familial persistent Müllerian duct syndrome

Two phenotypically normal pre-adolescent brothers with bilateral undescended testes were found to have bilateral fallopian tubes, a uterus and a vagina that drained into the prostatic utricle. We have documented this condition radiographically for the first time, gained some insight into the pattern of inheritance and made recommendations for surgical management.