Prostatic utricle cyst
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A prostatic utricle cyst (PUC), also known as a utricular cyst, is an area of focal dilatation that occurs within the prostatic utricle.
They are midline cystic masses in the male pelvis and can be very difficult or impossible to distinguish from a Mullerian duct cyst.
Utricle cysts are most often detected in the 1st and 2nd decades of life (Mullerian duct cysts usually occur in the 3rd and 4th decades).
The incidence of prostatic utricle cyst ranges around 11-14% in association with hypospadias or intersex anomalies and up to 50% in the presence of perineal hypospadias 3.
Association of prostatic utricle cysts with a variety of genitourinary abnormalities is recognized and include:
Mullerian duct cysts have no such associations 1.
The clinical presentation of utricular cysts is variable and includes pelvic mass, obstructive and irritative urinary tract symptoms, hematuria, and suprapubic or rectal pain.
Urine may pool in utricle cysts, since they communicate with the urethra, occasionally resulting in post-void dribbling. Some patients may be asymptomatic.
Prostatic utricle cysts always arise from the level of the verumontanum and are always in the midline. Mullerian duct cysts can arise anywhere along the path of Mullerian duct regression, from scrotum to utricle.
Utricle cysts are variable in size but are usually smaller (commonly <10 mm) than Mullerian duct cysts and usually do not extend above the prostate gland (Mullerian duct cysts typically extend above the prostate gland).
Seen as midline prostatic cyst.
- utricle cysts may contain pus or hemorrhage if infected
- utricle cysts may contain cancer (e.g. clear cell carcinoma, or squamous cell carcinoma) with a reported prevalence as high as 3% 5
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