Clinical spectrum and management options for prostatic utricle in children
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Read the article on jpedsurg.org ↗Article · Jan 2022 · 1 min read
In brief
In brief
Retrospective study of 36 male children with prostatic utricle found on cystoscopy shows 16.7% developed epididymo-orchitis, all with Grade II utricles. Multiple treatment approaches—from antibiotics to laparoscopic excision—were successfully individualized based on anatomy and symptoms, with all patients remaining asymptomatic at follow-up.
Written by the GCMD Library team from the article.
Purpose
Prostatic utricle (PU) has been described in children with hypospadias, posterior urethral valves (PUV), variances of sex characteristics and normal external genitalia. Intervention may be required in symptomatic cases, but clinical characteristics vary, requiring individualisation of management. We describe our experience with this condition.
Methods
Retrospective review of males noted to have PU on cystoscopy (2009–2020) at a single centre. Presentation, management and outcomes were recorded (Variances of sex characteristics excluded).
Results
Of 1060 male children who underwent cystoscopy for various reasons, PU was recorded in 36 (3.4%), indications for cystoscopy being hypospadias in 28, PUV in 3, urinary tract infections (UTI) in 3 and hydronephrosis in 2. Six (16.7%) developed epididymo-orchitis. All 6 had Ikoma Grade II PU. Case 1 (16 years,UTI) was managed with intravenous antibiotics. Case 2 (8 years,hypospadias) underwent laying open of urethral stricture. Case 3 (5 years,PUV) underwent laparoscopic PU excision. Cases 4 and 5 (3 and 6 years, hypospadias) underwent cystoscopic injection of bulking agent near the insertion of the vasa. Case 6 (3 years,hypospadias) underwent laparoscopic PU excision with vasal disconnection (vasal openings at dome of utricle rather than base) following failed endoscopic management. Median follow-up was 36 (0-206) months. All remained asymptomatic with normal testicular volumes for age at current follow-up.
Conclusion
Multiple treatment options to address a symptomatic PU have been described and enable surgeons to individualise treatment based on clinical circumstances. It is important to identify variations in anatomy of vasal connection to PU to plan appropriate management.