Endoscopic marsupialization of a prostatic utricle cyst: A case report and literature review of an unusual clinical condition

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INTRODUCTION: Prostatic utricle cysts are uncommon clinical conditions often associated with urogenital abnormalities. These cysts arise due to incomplete or aberrant regression of the Müllerian duct during embryological development. While predominantly asymptomatic, they can present with a range of clinical manifestations, including lower urinary tract symptoms, recurrent urinary tract infections or hematospermia. They are frequently associated with urogenital abnormalities like hypospadias, and rarely occur in individuals with normal external genitalia. PRESENTATION OF CASE: This report describes the case of a 25-year-old Caucasian male with normal external genitalia who presented with painful ejaculation and hematospermia, ultimately diagnosed as a highly symptomatic prostatic utricle cyst after ultrasonography and magnetic resonance imaging. The condition was effectively managed with a transurethral cyst marsupialization. DISCUSSION: Prostatic utricle cysts are rare congenital anomalies typically associated with urogenital malformations. This case is unusual because no such anomalies are present. Diagnosis relies on imaging modalities such as ultrasonography, voiding cystourethrogram, retrograde urethrography, cystoscopy, and magnetic resonance imaging. Differential diagnosis includes Müllerian duct cysts, urachal cysts and seminal vesicle cysts. Symptomatic cases may require surgical intervention. Endoscopic approaches, including marsupialization, have the advantage of lower morbidity compared to complete surgical cyst resection, from open surgery to robotic-assisted techniques, despite having a higher risk of recurrence. CONCLUSION: This case illustrates the successful diagnosis and endoscopic management of a symptomatic utricle cyst in a male with normal genitalia. Transurethral marsupialization proved effective and safe, with sustained symptom resolution.

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