|Year : 2004 | Volume
| Issue : 2 | Page : 184-185
Asymptomatic large prostatic utricle
Anjali Bhosle, Snehal Patel, Mahesh Desai
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
Head of Urology, Unit II, Muljibhai Patel Urological Hospital, Sir Virendra Desai Road, Nadiad - 387 001
Source of Support: None, Conflict of Interest: None
Keywords: Prostate, utricle
|How to cite this article:|
Bhosle A, Patel S, Desai M. Asymptomatic large prostatic utricle. Indian J Urol 2004;20:184-5
| Case Report|| |
A 11-year-old male presented with an urethrocutaneous fistula post-penosrotal hypospadias repair done in childhood. He had a left undescended testis for which left orchidectomy was done. On examination, he had a small fistula in the anterior urethra of 0.5 cm diameter with underdeveloped scrotum and absent left testis. A preoperative cystoscopy carried out before the fistula repair, revealed an opening at the verumontanum going into a blind cavity [Figure - 1]. Rest of the urethra and bladder was normal. A contrast study was carried out on table to judge the exact extent of the cavity and its relation with the bladder neck. The contrast study confirmed a prostatic utricle of type II variety [Figure - 2]. He underwent circumferential excision of fistula and double-layered closure of the fistulous opening. A per urethral catheter was passed over a guide wire to avoid its going into the prostatic utricle. Postoperative course was uneventful and no treatment was done for the prostatic utricle. Patient was kept on regular follow-up and any evidence of infection in the utricle will demand its excision in future.
| Comments|| |
The origin of prostatic utricle is reported to be the paramesonephric duct for the cranial part, and the urogenital sinus, mesonephric and paramesonephric ducts for the caudal segment. Penoscrotal and perineal hypospadias are associated with other congenital anomalies like undescended testis and prostatic utricle. The incidence of enlarged prostatic utricle in patients with penoscrotal or perineal hypospadias is 14% and the occurrence rate will be greater if associated cryptorchidism is present. 
The diagnosis of prostatic utricle is easily obtained with appropriate radiological studies like retrograde urethrography or voiding cystourethrography. The contrast medium fills the tubular structure posterior to the prostate and the bladder. This is prostate utricle and it can be graded as proposed by Ikoma.  Grade 0 - confined to the verumontanum, Grade I - extent of utricle below the bladder neck, Grade II - extends above the bladder neck, Grade III - opening of the utricle is distal to the external sphincter. The patient in our case report falls into Grade II variety. This grading system has proved useful in assessing the degree of utricular configuration associated with hypospadias and its direct relationship between the two. The increasing grade of utricle is associated with intersex. A preoperative urethrocystoscopy before hypospadias repair confirms the opening of utricle and a guide to the bladder and prevents inadvertent catheterization of the opening, so it is always advisable to pass a perurethral catheter over a guide wire.
The indications for treatment of a larger utricle are based on patient's symptoms like infection, post-void dribbling and urethral discharge. Asymptomatic patients inspite of having a large utricle need not undergo intervention and surgical excision, but requires reassurance and close observation and follow up. The chances of associated infertility has to be explained to the patient. Various techniques have been advocated for excision of utricle by open suprapubic, transvesical, posterior or perineal route and laparoscopic excision. The patient in our case report was totally asymptomatic for the utricle and hence only urethrocutaneous fistula repair was carried out and kept on regular follow-up.
| References|| |
|1.||Devine CJ. Gonzalez-Serva L. Stecker JF. Horton CE. Utricular configuration in hypospadias and intersex. J Urol 1980; 123: 407-11. |
|2.||Ikoma F, Shima H. Yabumoto H. Classification of enlarged prostatic utricle in patients with hypospadias. Br J Urol 1985; 57: 334-7. |
[Figure - 1], [Figure - 2]