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      An acute urinary retention in an old man caused by a giant müllerian duct cyst: a case report

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          Abstract

          Müllerian duct cysts result from an abnormality in regression of the Müllerian system. They may occasionally give rise to symptoms. We report an unusual case of acute urinary retention in an old man caused by a giant Müllerian duct cyst.

          A 77-year-old man presented with of acute urinary retention. After bladder drainage, digital rectal examination found a large soft supraprostatic mass. Transrectal ultrasound and computed tomography scans revealed a large multilocular retrovesical cystic mass. The patient underwent open surgical resection of the cyst. Histologically, the cystic lesion was lined with stratified cubocolumnar cells, consistent with a Müllerian duct cyst.

          Acute urinary retention in the elderly is not always related to prostatic diseases. Other causes, even congenital ones, may be involved

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          Adult müllerian duct or utricle cyst: clinical significance and therapeutic management of 65 cases.

          We define guidelines for the exploration and treatment of adult müllerian duct cysts. From January 1988 through September 1999 a diagnosis of enlarged prostatic utricle was made in 65 adults based on transrectal ultrasound findings. Echographic criteria to define simple versus complicated cysts were detailed. We reviewed the clinical presentation, diagnostic modalities, indications for invasive procedures and postoperative outcome. The usual clinical presentations were hematospermia in 40% of cases, other ejaculatory disturbances in 20%, recurrent testicular or pelviperineal pain in 33%, lower urinary tract irritation symptoms in 25%, lower urinary tract infection in 18.5%, male infertility in 12% and incidental finding in 18.5%. Cyst dimensions did not influence the indication for invasive procedures, which were performed in only 27 of the 65 patients (41.5%) to treat disabling symptoms in 28% and obstructive infertility in 5%, and investigate complicated cysts on transrectal ultrasound in 6%. These procedures included transperineal or transrectal puncture in 9 patients, simple endoscopic section of the utricle meatus in 12 and large marsupialisation in 6. Complete and sustained cure was noted in half of the patients treated with cyst puncture only, although echographic relapse was the rule. Endoscopic procedures definitely improved or cured 82% of the patients at a mean followup of 51 months, during which neither early nor late complications were noted. Since almost 60% of adults diagnosed with a müllerian duct cyst did not experience any cyst related symptoms or ejaculatory-fertility impairment, we recommend that investigation and/or treatment should only be done in symptomatic or infertile patients.
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            Surgical treatment of the Müllerian duct remnants.

            Persistent Müllerian duct tissue in male individuals may result in an enlarged prostatic utricle (utricular cysts and utricle) or a Müllerian duct cysts, either distinctively or synonymously. In intersex patients Müllerian duct remnants (MDR) are an usual occurrence. Surgical excision is the definitive treatment of symptomatic remnants, as well as during the reconstruction of intersexual genitalia. Many approaches have been described. The authors review their experience in intersex patients. From 1986 to 1999, the authors treated 111 patients with intersex disorders. The records of 47 patients raised as boys with MDR were reviewed. Based on the symptoms and the size of the remnants, in 32 patients the structures were removed. In 13 patients extirpation was done by perineal approach, in 9 by transperitoneal approach, and in the remaining 9 patients the combined abdominal and perineal approach were undertaken. In one patient the large prostatic utricle was extirpated by a posterior sagittal pararectal approach. Perineal approach was mainly used in younger asymptomatic children, with the prostatic utricle disclosed incidentally during genitography because of intersex disorders. Operation was performed only in cases in which the prostatic utricle was observed by cystoscopy or identified by Fogarty balloon catheter introduction into the prostatic utricle. In older patients these structures were discovered frequently after failed urethroplasty, or after symptoms of urinary infection, urinary retention, or epididymitis. We elected to use the transperitoneal approach based on the extension of these structures into the pelvis. The average age of patients at the time of surgery was 8.6 years, with a range of 1 to 30 years. There were no rectal or bladder injuries during surgery. An older patient had temporary impotence after abdomino-perineal extirpation. The lack of ejaculation, seen in 5 patients, was related to frequent intra-utricular termination of the vas deferens. Posterior sagittal pararectal approach certainly enabled complete exposure and exact visualization of all structures, with considerably decreased bleeding. If gonadal biopsy or gonadectomy were necessary, the transperitoneal approach could not be avoided. Surgical treatment of MDR in intersex patients varies according to the size of the utricle, and a double approach is often necessary. A high degree of success may be achieved with minimal morbidity. J Pediatr Surg 36:870-876. Copyright 2001 by W.B. Saunders Company.
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              Müllerian duct remnants: surgical management and fertility issues.

              We reviewed our experience with mullerian duct remnants, also known as prostatic utricular and mullerian duct cysts, to advance further the understanding of the surgical management of these challenging congenital anomalies. The indications, merits and disadvantages of each surgical approach are presented, and the effects of mullerian duct remnants and their treatment on future fertility are discussed. We reviewed the records of 26 patients 1 month to 19 years old with mullerian duct remnants who were seen between January 1984 and October 1998. Clinical presentation included perineoscrotal hypospadias in 10 cases, urinary retention and/or difficult voiding in 7, urinary tract infection in 6, acute scrotum in 2, and recurrent hemospermia and dysuria in 1. Of the 26 patients 13 required surgical intervention for various symptoms and to correct large diverticula. The surgical approach was transvesical transtrigonal in 8 cases, extravesical in 2, perineal in 2 and posterior sagittal in 1. Transurethral fulguration was performed in 2 cases. The initial surgical approach was successful in 11 of the 13 patients. One patient required conversion to a transvesical transtrigonal approach due to inadequate exposure during attempted perineal excision. Two cases treated with transurethral fulguration failed to resolve completely, and in 1 excision was required using the transvesical transtrigonal technique. A total of 13 patients were treated nonoperatively, including 10 in whom the condition was discovered incidentally during screening for perineoscrotal hypospadias. In 5 of the 10 patients urinary tract infection subsequently developed and they were maintained on long-term chemoprophylaxis. By tailoring the surgical approach to the type of mullerian duct remnant and the relevant anatomical relationships a high degree of success may be achieved with minimal morbidity.
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                Author and article information

                Journal
                Cases J
                Cases Journal
                BioMed Central
                1757-1626
                2009
                18 November 2009
                : 2
                : 203
                Affiliations
                [1 ]Urology Department, Sahloul University Hospital, Sousse, Tunisia
                Article
                1757-1626-2-203
                10.1186/1757-1626-2-203
                2783152
                19946447
                3b97b2a1-a13e-4354-9db4-a5469cbb675c
                Copyright ©2009 Jaidane et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 October 2009
                : 18 November 2009
                Categories
                Case Report

                Medicine
                Medicine

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