Prostatic utricle cyst

Last revised by Joshua Yap on 11 May 2023

A prostatic utricle cyst, 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 Müllerian duct cyst.

Utricle cysts are most often detected in the 1st and 2nd decades of life (Müllerian duct cysts usually occur in the 3rd and 4th decades). 

The incidence of prostatic utricle cysts ranges around 11-14% in association with hypospadias or intersex anomalies and up to 50% in the presence of perineal hypospadias 3.

Prostatic utricle cysts are associated with a variety of genitourinary abnormalities including:

Müllerian 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. Müllerian duct cysts can arise anywhere along the path of Müllerian duct regression, from the scrotum to the utricle.

Utricle cysts are variable in size but are usually smaller (commonly <10 mm) than Müllerian duct cysts and usually do not extend above the prostate gland (Müllerian duct cysts typically extend above the prostate gland).

Seen as a 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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Cases and figures

  • Case 1a: retrograde cystoscopy
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  • Case 1b: ultrasound
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  • Case 2: probable
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  • Case 3: MRI
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  • Case 4
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  • Case 5
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  • Case 6: with undescended testis
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  • Case 7: neonatal prostatic utricle abscess/cyst
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  • Case 8: with perianal fistula
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