A Rare Case of Partial Unilateral Corpus Cavernosum Agenesis With Concomitant Multiple Genitourinary Anomalies.

Congenital penile agenesis is a rare condition with an incidence of 1 in 30 million, while other congenital malformations of the cavernous bodies are much less common. In a few cases in the literature, it has been reported that the reason for consulting a physician with these conditions is the insufficient erection. As a first reported case, we present a 16-year-old male patient with partial unilateral corpus cavernosum agenesis accompanying genitourinary anomalies.

Urine-Filled Large Prostatic Cystic Structure in Two Unrelated Male Miniature Dachshunds.

A 1 yr old intact male miniature dachshund presented for posturing to urinate without voiding and nocturia. Physical examination revealed congenital reproductive abnormalities and a fluid-filled structure caudal to the urinary bladder. The dog was diagnosed with a prostatic cyst and underwent an exploratory laparotomy with an attempt to remove the cyst. Twelve weeks later, the dog returned with recurring clinical signs, and the cyst was found to have returned back to its original size. A second intact male miniature dachshund presented at 7 mo of age for stranguria. Physical examination revealed congenital reproductive abnormalities and a fluid-filled structure on rectal palpation, much like the first dog. The dog was diagnosed with a prostatic cyst and underwent an exploratory laparotomy. An attempt was made to close communication between the prostate and cyst. The dog re-presented 3 wk later for recurrence of clinical signs, and the prostatic cyst was found to have increased in size. Both dogs were euthanized because of recurrence of clinical signs. This report describes the presence of prostatic cysts in two young dogs with congenital abnormalities of the genital and reproductive tracts and the similarities seen in human boys diagnosed with prostatic utricles.

Long term outcomes of laparoscopic-assisted anorectoplasty: a comparison study with posterior sagittal anorectoplasty.

PURPOSE: The aim of this study is to compare the long term outcomes between laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for children with rectobladderneck and rectoprostatic fistula anorectal malformations (ARM). METHODS: Thirty-two ARM children with rectobladderneck and rectoprostatic fistula who underwent LAARP between October 2001 and March 2012 were reviewed. The outcomes were compared with those of 34 ARM children who underwent PSARP between August 1992 and September 2001. The sacral ratio (SR), age at operation, operative time, postoperative hospital stay and complications were evaluated. Bowel functions were assessed using the Krickenbeck classification. RESULTS: The mean operative time of the LAARP was significantly shorter than that of PSARP group (1.62 ± 0.40 vs 2.13 ± 0.30 h). The postoperative hospital stay was significantly shorter in the LAARP group (5.8 ± 0.65 vs 8.4 ± 0.67 h). The wound infections (11.8% vs 0%) and recurrent fistula (11.8% vs 0%) were more common in PSARP patients. Th e overall morbidity rate of PSARP group was significantly higher than that of the LAARP group (35.3% vs 12.5%, p<0.05). However, 7.5% of the LAARP patients developed rectal prolapse. Twenty-four of 32 patients were followed up for more than 3 years in LAARP group. The median follow up period was 7.5 years (range 4-11) in LAARP patients and 15.5 years (range 11-20) in PSARP patients. The rates of voluntary bowel movement, soiling (grade 1, 2 & 3) were similar in both groups. More patients from PSARP group developed grade 2 or 3 constipation (22.5% vs 0%, P<0.01). CONCLUSIONS: Compared to PSARP, LAARP is a less invasive procedure. The long term functional outcomes after LAARP were equivalent if not better than those of PSARP.

[Ejaculatory duct obstruction]. / Obstrucción de conductos eyaculadores.

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

Obstrucción de conductos eyaculadores / Ejaculatory duct obstruction

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

Imaging the pediatric prostate.

The prostate gland is not often the target of imaging in children but may be imaged during investigation of symptoms related to the lower genitourinary tract such as hematuria, urinary retention, dysuria, and incontinence or during an evaluation for suspected congenital anomalies. Ultrasound and voiding cystourethrography are useful for initial evaluation of congenital and neoplastic disorders of the prostate. MR imaging and CT are useful in delineating more detailed anatomy before surgical planning and in determining the organ of origin in a patient who has a large pelvic mass.

An unusual case of a prenatally detected large mullerian duct remnant.

Mullerian duct remnants presenting in childhood are often diagnosed incidentally and when symptomatic, typically present with recurrent infection and/or voiding disturbances. We present a rare unusual case of a male neonate who presented with a prenatally detected large pelvic cyst that turned out to be a giant prostatic utriculus.

Primary male infertility caused by congenital prostatic cyst: sonographic and magnetic resonance imaging findings.

Congenital cysts in the midline of the prostate gland can cause obstruction of the ejaculatory ducts leading to congestion and dilation of the seminal vesicles with the result of small volume ejaculate or infertility. We report the case of a patient who underwent transrectal ultrasound and magnetic resonance imaging for evaluation of primary male infertility. The images obtained revealed a congenital cyst of the prostate gland. Transurethral marsupialization of the cyst subsequently resulted in normalization of the semen analysis and restitution of the patient's fertility.

Prostatic cyst. An unusual but important finding in male urogenital dysfunction.

Prostatic cysts are one of the uncommon congenital disorders, and only a few cases have been reported. This lesion actually includes two different entities on the embryological development basis, the enlarged prostatic utricle and the cystic remnants of the müllerian ducts. We report two patients with prostatic cysts, probably two prostatic utricle cysts. In both cases the cyst caused significant urogenital dysfunction. The patients were cured by endoscopic unroofing of the cysts. We discuss the embryogenesis, diagnosis and treatment by reviewing the literature.

[Urogenital malformation complex including the Mullerian system]. / Urogenitaler Missbildungskomplex mit Einbeziehung des Müller-Systems.

Symptomatic cystic epididymis in a 21-year-old man led to the detection of several genital malformations, including a partially obstructing pelvic cyst, prostatic and bilateral testicular atrophy and penoscrotal hypospadias. These malformations are probably due to a deficiency of either testosterone or müllerian inhibiting hormone (MIH). Development of the male genitalia is influenced by testosterone secreted in the Leydig cells during weeks 8-16 of gestation, while regression of the müllerian ducts is induced by MIH secreted in the Sertoli cells from weeks 9-12 of gestation.

Congenital prostatic cyst causing ejaculatory duct obstruction: management by transrectal cyst aspiration.

Congenital prostatic cysts are relatively uncommon and rarely symptomatic. We describe a 24-year-old man who presented with a 2-month history of anejaculation accompanied with bilateral epididymal pain. Transrectal ultrasonography of the prostate revealed a large midline prostatic cyst and bilateral dilatation of the seminal vesicles. Transrectal aspiration of the cyst resulted in return of antegrade ejaculation and resolution of epididymal pain.

[Müllerian cyst. Apropos of a case of the prostatic region]. / Kyste müllérien. A propos d'un cas de la région prostatique.

One case of the unusual entity, prostatic müllerian duct cyst, is reported. Depending on their volume, they may, like in our case-report, or may not be symptomatic. Ultrasonography, C.T. scan and vasoseminal vesiculogram precised its midline location and its relationships with other adjacent anatomic structures. The endo-uretral approach to drainage was used successfully.

Surgical treatment of utricular cyst in male child.

A simple technique for management of utricular cyst is presented. Essentially the technique consists of putting a Fogarty balloon catheter in the cyst through a perineal urethrostomy and inflating the balloon to fill the cyst completely. Using a miniature resectoscope, the septum between the cyst wall and prostatic urethra is resected widely until the Fogarty Balloon is completely visualized in the prostatic urethra.