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.
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Epidemiology
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.
Associations
Prostatic utricle cysts are associated with a variety of genitourinary abnormalities including:
unilateral renal agenesis
anorectal malformations e.g. imperforate anus
Müllerian duct cysts have no such associations 1.
Clinical presentation
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.
Pathology
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).
Radiographic features
MRI
Seen as a midline prostatic cyst.
Treatment and prognosis
Complications
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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