The prevalence of cystic abnormalities of the prostate involving the ejaculatory ducts as detected by transrectal ultrasound

Percutaneous resection of anteriorly located midline prostatic cyst: A case report and description of technique

•

Anterior midline prostatic cysts are very rare.

•

They might cause sever urinary symptoms.

•

They are usually treated with transurethral resection of the prostate.

•

Occasionally, transurethral resection is not feasible due to cyst location.

•

Percutaneous resection of the cyst is a safe alternative if indicated.

Introduction

Midline prostatic cysts are common and are usually discovered incidentally. However, anterior midline prostatic cysts are considered rare.

Presentation of Case

We report a 36-year-old man who presented with severe lower urinary tract symptoms. The patient was diagnosed with an anterior midline prostatic cyst bulging into the bladder. The location of the cyst did not allow for a safe transurethral resection. He was managed successfully through a percutaneous approach.

Conclusion

Percutaneous resection of an anteriorly located prostatic cyst is simple and safe. This procedure is advised if bladder neck injury is possible during transurethral resection to avoid retrograde ejaculation.

Novel insight for midline cyst formation in prostate: The involvement of decreased prenatal testosterone suggested by second-to-fourth digit ratio study

OBJECTIVES

To clarify the relationship between midline cyst formation and second to fourth finger length ratio.

METHODS

The present study included 95 benign prostatic hyperplasia patients and 61 healthy male college students. All midline cysts were identified by transrectal ultrasonography. In the benign prostatic hyperplasia group, 45 midline cyst (+) men (M(age) = 67.2 years) and age-matched 50 midline cyst (-) men (M(age) = 67.1 years) were included. In the university student group, 12 midline cyst (+) men (M(age) = 21.7 years) and age-matched 49 midline cyst (-) men (Mage = 21.1 years) were included. We took photocopies of the participants' bilateral hands, and measured the second and fourth finger length was measured by one examiner in a blind manner.

RESULTS

Second to fourth finger length ratios in the benign prostatic hyperplasia group (right/left mean ± SD) were higher bilaterally in midline cyst (+) (0.95 ± 0.03/0.95 ± 0.03) than those in midline cyst (-) (0.92 ± 0.03/0.92 ± 0.03; P < 0.0001/P = 0.0010). Second to fourth finger length ratios in students were higher only in the right hand in midline cyst (+) (0.96 ± 0.03/0.94 ± 0.03) than those in midline cyst (-) (0.93 ± 0.03/0.94 ± 0.03; P = 0.0018/P = 0.9968). The second to fourth finger length ratio of midline cyst (+) men was significantly higher than that in midline cyst (-) men.

CONCLUSIONS

The second to fourth finger length ratio is higher in subjects with midline cyst of the prostate. It can be speculated that the prostatic utricle dilates in cases less exposed to male hormones during fetal development.

Ejaculatory duct obstruction

Ejaculatory duct obstruction presents with infertility, pain, or hematospermia. Partial or functional forms of ejaculatory duct obstruction can be difficult to diagnose. Transrectal ultrasound has replaced formal vasography as the first-line diagnostic test but is not specific. Adjunctive procedures such as seminal vesicle aspiration, seminal vesiculography, and chromotubation further delineate the diagnosis. Using an evidence-based approach, this article reviews how best to approach the diagnosis and treatment of ejaculatory duct obstruction.

Infections of the genitourinary tract and refertilisation operations

Infections of the urinary tract are the aetiological reasons for primary infertility in up to 9% of infertile men. Taking into account that post-operative infection following vasovasostomy can lead to closure of the realigned deferent duct, special consideration should be given to consultation and treatment of vasovasostomy patients. In this paper, the influence of infection on operating procedures in infertility is described.

Midline intraprostatic cyst: An unusual cause of lower urinary tract symptoms

Symptomatic prostatic cyst presenting as obstructive lower urinary tract symptoms (LUTS) is an infrequent diagnosis in males. Midline cysts are much more likely to obstruct the bladder outlet. We report our experience with four such cases in the last one year, along with a short review of the literature. Two of these cases had additional presenting symptoms besides LUTS - febrile Urinary tract infection (UTI) with perinephric abscess and primary infertility. One case had an anterior midline prostatic cyst which is an extremely rare entity. The remaining three had midline posterior cysts. All cases were treated with transurethral marsupialization, had good relief of symptoms and no adverse effects.

Clinical features and management of anterior intraurethral prostatic cyst

We report on a symptomatic anterior intraurethral prostatic cyst in a 46-year-old man without clinical evidence of benign prostatic hyperplasia. The anterior location of this cyst makes it unique to all previously reported cases of prostatic cysts which are located posteriorly. Transurethral resection of the cyst with limited resection of the anterior prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms. In the absence of lateral lobe hypertrophy, standard transurethral resection of the prostate should be avoided to ensure preservation of erectile and ejaculatory function.

Transurethral deroofing of midline prostatic cyst for subfertile men

We evaluated the efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with one or more of the following semen abnormalities: decreased ejaculatory volume, decreased sperm motility and oligo- or azoospermia. Results from treatment of a series of 11 subfertile men with a midline prostatic cyst by transurethral deroofing of the cyst are presented. Five patients showed an improvement of seminal volume. Only one patient demonstrated an improvement of sperm count. Sperm motility was not influenced. No relationship was found between positive outcome following operation and either size of the cyst or dilatation of the seminal vesicles. Spontaneous pregnancies did not occur after transurethral deroofing of the midline prostatic cyst. In conclusion, our study suggests a poor efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with the above mentioned semen abnormalities.