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Hu JJ, Zhao YW, Tu L, He TQ, Chen YF, Wen R, Peng QL. Clinical Application of Ureteroscope-Assisted Laparoscopic Surgery for Prostatic Utricle in Children. J Laparoendosc Adv Surg Tech A 2024; 34:182-188. [PMID: 37902957 PMCID: PMC10875244 DOI: 10.1089/lap.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Purpose: To investigate the use of ureteroscope-assisted laparoscopic surgery (UALS) in treating symptomatic prostatic utricle (PU) in children. Materials and Methods: Data on surgically treated cases of PU at the Department of Urology in Hunan Children's Hospital between September 2014 and September 2022 were retrospectively collected and analyzed. The diagnosis was confirmed by cystourethroscopy followed by ureteroscopy, and PU was excised by ureteroscope-assisted laparoscopy. Results: A total of 21 patients with PU were enrolled in this study. The median age of the patients at surgery was 8.1 (4.6-11.5) years. Karyotyping was available for 15 children: 13 (86.7%) were 46XY, 1 (6.7%) was 45X/46XY, and 1 (6.7%) was 45X/46XY/47XYY. The median length of the PU was 5.0 (4.1-7.1) cm. Nineteen patients underwent only ureteroscope-assisted laparoscopic excision, whereas 2 also had a perineal incision. All excisions were successfully performed. The median intraoperative blood loss was 25.0 (20.0-37.5) mL. The median hospital stay and follow-up durations were 18.0 (14.5-25.0) days and 24.0 (13.5-49.0) months, respectively. The patients reported no postoperative clinical symptoms. Conclusion: UALS allows for accurate patient positioning and thorough exposure of the anatomical structures, and it is a safe, effective, and minimally invasive treatment for PU in children.
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Affiliation(s)
- Jian-Jun Hu
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Yao-Wang Zhao
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Lei Tu
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Tian-Qu He
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Yi-Fu Chen
- Department of Urology and Hunan Children's Hospital, Changsha, China
| | - Rong Wen
- Department of Pathology, Hunan Children's Hospital, Changsha, China
| | - Qian-Long Peng
- Department of Urology and Hunan Children's Hospital, Changsha, China
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Welsh PJ, McDaniel K, Goldsmith EW, Ramsay JD, Conley A, Owen TJ, Ambrosini YM, Ciccarelli M. Case report: Persistent Müllerian duct syndrome and enlarged prostatic utricle in a male dog. Front Vet Sci 2023; 10:1185621. [PMID: 37470070 PMCID: PMC10352618 DOI: 10.3389/fvets.2023.1185621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 07/21/2023] Open
Abstract
A 1-year-old male intact Miniature Schnauzer mix was presented for chronic intermittent hematuria. Abdominal ultrasonography revealed a large, fluid-filled cystic structure extending cranially and dorsally to the prostate. Computed tomography scan images revealed that the fluid-filled cavity resembled a uterus, with both horns entering the scrotum through the inguinal canal adjacent to the testes. On cytogenetic analysis, the dog was found to have a homozygote mutation on AMHRII consistent with persistent Müllerian duct syndrome (PMDS). A gonadohysterectomy was performed, and surgical and histologic findings confirmed the presence of a uterus, oviducts, vagina, and testes in this dog. Additionally, an intraoperative fluoroscopy exam revealed a communication between the uterus and the bladder via an enlarged utricle, explaining the hematuria and urine in the reproductive tract (urometra). To our knowledge, this is the first clinical report of a phenotypically intact male dog with PMDS and urometra due to an enlarged prostatic utricle. This case illustrates a combination of a disorder of sex and urogenital sinus development.
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Affiliation(s)
- Peter J. Welsh
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, United States
| | - Kaylyn McDaniel
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, United States
| | - Elizabeth W. Goldsmith
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman, WA, United States
- Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, WA, United States
| | - Joshua D. Ramsay
- Pathology Services, North American Science Associates, Minneapolis, MN, United States
| | - Alan Conley
- School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Tina Jo Owen
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, United States
| | - Yoko M. Ambrosini
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, United States
| | - Michela Ciccarelli
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, United States
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Sengar M, Khan NA, Siddiqui Y, Mohta A, Gupta A, Gupta CR. Newer Insights into Prostatic Utricle in Proximal Hypospadias. J Indian Assoc Pediatr Surg 2022; 27:387-390. [PMID: 36238343 PMCID: PMC9552648 DOI: 10.4103/jiaps.jiaps_96_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/30/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Prostatic utricles (PUs) are the remnants of Mullerian ducts found in the male posterior urethra. Enlarged symptomatic utricles are known to be associated with hypospadias. There is a dearth of literature defining an enlarged utricle and also its clinical significance. Aims The aim of this study was to describe anatomical difference of PUs of cases with severe hypospadias and also to find their clinical significance if any. Materials and Methods A prospective study was carried out, and all patients with proximal hypospadias were enrolled. Cystoscopy was performed in all cases. Symptomatology, size, and location of PU were recorded. PU of >0.5 cm was considered enlarged. Results In the present series, a total of 70 cases were included over a period of 2 years. Enlarged utricle was found in 47/70 (67.14%) on cystoscopy. They were wide-mouthed and negotiated 9 Fr/11 Fr cystoscope with ease. Recurrent epididymo-orchitis, recurrent urinary tract infection, and obstructive features were the most common complications requiring intervention. Conclusions PUs in boys with hypospadias are enlarged as well as wide-mouthed. Most of these remain asymptomatic, but few of them carry the potential of complications. Cystoscopy helps in direct visualization of utricular anatomy, so it should be a preferred investigating modality for investigating a PU.
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Affiliation(s)
- Mamta Sengar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India,Address for correspondence: Dr. Niyaz Ahmed Khan, Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi - 110 031, India. E-mail:
| | - Yousuf Siddiqui
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Anup Mohta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Alisha Gupta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Chhabi Ranu Gupta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
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Oshima K, Kanematsu A, Hashimoto T, Shimatani K, Nojima M, Yamamoto S. Urinary retention in adult hypospadias patient resolved by unroofing of a mildly enlarged prostatic utricle. IJU Case Rep 2021; 4:114-117. [PMID: 33718822 PMCID: PMC7924089 DOI: 10.1002/iju5.12257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION A prostatic utricle is a congenital saccular indentation in the prostatic urethra and frequently enlarged in hypospadias patients. We present a case of urinary retention associated with a mildly enlarged utricle. CASE PRESENTATION A 20-year-old male, who underwent multiple repair procedures for hypospadias during childhood, was referred to us for dysuria. Retrograde urethrogram, voiding cystourethrogram, and cystoscopy results revealed only a mildly enlarged prostatic utricle, with no apparent lower urinary tract obstruction or urethral valves. A meatotomy was performed under suspicion of meatal stenosis, though urinary retention occurred following that procedure. Transrectal ultrasonography revealed flapping of the prostatic urethra floor over the utricle. Transurethral unroofing of the utricle relieved the dysuria. CONCLUSION A mildly enlarged prostatic utricle can cause dysuria. To the best of our knowledge, no case similar to the present has been previously reported.
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Affiliation(s)
- Koichi Oshima
- Department of UrologyHyogo College of MedicineNishinomiyaHyogoJapan
| | | | | | | | - Michio Nojima
- Department of UrologyHyogo College of MedicineNishinomiyaHyogoJapan
| | - Shingo Yamamoto
- Department of UrologyHyogo College of MedicineNishinomiyaHyogoJapan
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Boybeyi-Turer O, Demirbilek H, Soyer T. Cystoscopy-Guided Laparoscopic Excision of Prostatic Utricle: Report of a Case. European J Pediatr Surg Rep 2020; 8:e35-e38. [PMID: 32550124 PMCID: PMC7188514 DOI: 10.1055/s-0040-1705155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/10/2020] [Indexed: 10/27/2022] Open
Abstract
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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Affiliation(s)
- Ozlem Boybeyi-Turer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Huseyin Demirbilek
- Department of Pediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abstract
Aim: To report a series of scrotal abscess, a rare problem, their etiology, and management. Materials and Methods: A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management. Results: Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) [1]; three anorectal malformations with ectopic ureter [1], urethral stricture [1], and neurogenic bladder [1]; meconium peritonitis with meconium periorchitis [2], ileal atresia [1], and intra-abdominal abscess [1]; posturethroplasty for Y urethral duplication with metal stenosis [1] and idiopathic pyocele [1]. Transmission of the organism had varied routes include fallopian tube [1], urethra ejaculatory reflux [4], hematogenous [2], and the patent process of vaginalis [2]. Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics. Conclusion: Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter.
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Affiliation(s)
- Raghu S Ramareddy
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anand Alladi
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Villarreal DD, Villarreal H, Paez AM, Peppas D, Lynch J, Roeder E, Powers GC. A patient with a unique frameshift mutation in GPC3, causing Simpson-Golabi-Behmel syndrome, presenting with craniosynostosis, penoscrotal hypospadias, and a large prostatic utricle. Am J Med Genet A 2013; 161A:3121-5. [PMID: 24115482 DOI: 10.1002/ajmg.a.36086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/22/2013] [Indexed: 11/08/2022]
Abstract
We present a Hispanic male with the clinical and molecular diagnosis of Simpson-Golabi-Behmel syndrome (SGBS). The patient was born with multiple anomalies not entirely typical of SGBS patients, including penoscrotal hypospadias, a large prostatic utricle, and left coronal craniosynostosis. In addition, he demonstrated endocrine anomalies including a low random cortisol level suspicious for adrenal insufficiency and low testosterone level. To our knowledge, this is the first report of a prostatic utricle in SGBS and the second report of craniosynostosis. The unique disease-causing mutation likely arose de novo in the mother. It is a deletion-insertion that leads to a frameshift at the p.p. S359 [corrected] residue of GPC3 and a premature stop codon after five more amino acids. p. S359 [corrected] is the same residue that is normally cleaved by the Furin convertase, although the significance of this novel mutation with respect to the patient's multiple anomalies is unknown. We present this case as the perinatal course of a patient with unique features of SGBS and a confirmed molecular diagnosis.
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Affiliation(s)
- Diana D Villarreal
- Department of Cellular and Structural Biology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abstract
Complete excision of a prostatic utricle through posterior sagittal rectum retracting approach is reported in an infant.
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Affiliation(s)
- Mukunda Ramachandra
- Department of Paediatric Surgery, B.J.Wadia Hospital for Children, Parel, Mumbai, India
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Jiwane A, Soundappan SVS, Pitkin J, Cass DT. Successful treatment of recurrent epididymo-orchitis: Laparoscopic excision of the prostatic utricle. J Indian Assoc Pediatr Surg 2010; 14:29-30. [PMID: 20177442 PMCID: PMC2809460 DOI: 10.4103/0971-9261.54813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prostatic utricle presenting with recurrent epididymo-orchitis is not uncommon. Excision of prostatic utricle is the treatment of choice. The various techniques described in literature suffer from the disadvantages of incomplete excision due to poor view. We report the successful laparoscopic excision of prostatic utricle in childhood.
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Affiliation(s)
- Ashish Jiwane
- Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Australia
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