Laparoscopic Treatment of Prostatic Utricle in Children

Abstract

Large and pathologic utricles are uncommon. A dual origin seems to be admitted from endodermal urogenital sinus and mesodermal Müllerian and Wolffian ducts, explaining the common association between prostatic utricle and disorders of sexual development (DSD) or hypospadias. In large prostatic utricle, urinary symptoms can occur as incontinence, epididymitis, or urinary retention, and diagnosis is done by ultrasonography, voiding cystourethrogram, and MRI. The most common sign is the midline position of a “cyst” behind the bladder. When prostatic utricles are symptomatic, various techniques have been advocated, and now the laparoscopic approach offers a minimally invasive access to the retrovesical space, provides a clean view of the deep pelvic structures, and reduces the incidence of injury to the bladder, the rectum, the ureters, the vessels, and the pelvic nerves. In open and laparoscopic cases reported in the literature, the excision was complete without significant difference in terms of age, utricular size, or complications when compared to open surgery. Nowadays, the laparoscopic approach and the robot-assisted laparoscopy seem to be the best way to remove prostatic utricles.