Abstract
Background
Prostatic utricle (PU) with normal external genitalia is an uncommon congenital anomaly.
About 14% develop epididymitis. This rare presentation should warn involvement of
the ejaculatory ducts. Minimally invasive robot-assisted utricle resection is the
preferred method.
Objective
To describe a novel approach to PU, we hereby present the video of a case with PU
resection and reconstruction using a Carrel patch principle to preserve fertility.
Methods
A 5-month-old male presented with right side testicular orchitis and a large retrovesical
hypoechoic cystic lesion. Urine culture was positive. He responded well to oral antibiotics. A voiding urethrocystogram confirmed a large
PU. A breakthrough orchitis occurred 5 months later and the decision to proceed with
surgical resection was made. Robot-assisted PU resection was performed at 13 months
of age and 10 kg. Dissection of the utricle was guided with a flexible cystoscope
and intraoperative ultrasound. Both vas deferens were seen draining at the neck of
the PU making complete circumferential resection not feasible without compromising
the integrity of both seminal vesicles and vas deferens. To preserve fertility, a
PU flap including both seminal vesicles was preserved and anastomosed to the edges
of the resected PU following the Carrel patch principle. Postoperative course was
not complicated, and patient was discharged home on second postoperative day. A month
later, exam under anesthesia, circumcision, cystoscopy, and cystogram demonstrated
no contrast extravasation with otherwise normal anatomy. Foley catheter was then removed.
A year after the procedure patient has been asymptomatic with no new infection recurrence
and normal potty-training process.
Results
Symptomatic isolated PU is an uncommon presentation. Impact of recurrent orchitis
on future fertility is possible. Complete resection is difficult in cases where the
vas deferens enters the PU at its base crossing the midline. Our novel approach to
preserve fertility using the Carrel patch principle is feasible thanks to better visibility
and exposure enhancement provided robotically. Prior open attempts demonstrated be
technically difficult given the deep and anterior location of the PU. To our knowledge,
this is the first time such procedure is reported. The use of cystoscopy and intraoperative
ultrasonography are also valuable tools.
Conclusion
Reconstruction of PU is technically feasible and should be considered when risk of
future infertility can be compromised. After a 1-year follow-up, it is important to
continue to monitor long-term. Possible complications like fistula development, infection
recurrence, urethral injury and incontinence should be thoroughly discussed with parents.
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Article info
Publication history
Published online: March 27, 2023
Accepted:
March 4,
2023
Received:
December 22,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
