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UROLOGICAL IMAGES |
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| Year : 2018 | Volume
: 34
| Issue : 3 | Page : 231-232 |
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Brunn's cyst: A rare cause of lower urinary tract symptoms
Mohd Ilyas, Fahad Shafi, Naseer Choh
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| Date of Submission | 13-Apr-2018 |
| Date of Acceptance | 01-Jun-2018 |
| Date of Web Publication | 29-Jun-2018 |
Correspondence Address:
Mohd Ilyas
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/iju.IJU_117_18
 Abstract | | |
Brunn's cyst in the region of the bladder neck is a rare cause of lower urinary tract obstruction. This case describes the ultrasonographic and intra-venous urographic findings of Brunn's cyst in a 53-year-old male presenting with lower urinary tract symptoms.
How to cite this article:
Ilyas M, Shafi F, Choh N. Brunn's cyst: A rare cause of lower urinary tract symptoms. Indian J Urol 2018;34:231-2 |
| Introduction | |  |
Bladder outlet obstruction in an adult male usually results from either benign hyperplasia of the prostate or from a urethral stricture. Brunn's cyst is one of the rarest causes of bladder neck obstruction.[1] These cysts result from inflammation in the Brunn's nests located within the urothelium. They are seldom seen in the region of the bladder neck and rarely cause outlet obstruction.[2],[3]
| Case Report | | |
A 53-year-old male patient presented with the chief complaints of urinary hesitancy, increased urinary frequency, and urgency with a sense of incomplete voiding. His urine examination and serum chemistries were within normal limits.
Ultrasonography of the kidney urinary bladder (KUB) region revealed a 7 mm × 8 mm, small, well-defined cystic lesion at the bladder neck, separate from the ureterovesical junctions and above the prostate [Figure 1]. Bilateral upper tracts and the prostate were within normal limits. However, the post void residual urine was significant (>30% of the pre-void volume). | Figure 1: Sonographic images showing a small cystic lesion (arrow) in the bladder neck region above the prostate and separate from the ureterovesical junctions
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An intravenous urography revealed a small filling defect in the region of the bladder neck[Figure 2]. A radiological diagnosis of Brunn's cyst was formulated based on ultra-sonography and intravenous urography. The patient underwent transurethral de-roofing and resection of the cyst and after which his symptoms resolved. | Figure 2: Full bladder film of Intravenous urography showing the filling defect (arrow) in the bladder neck region. The sonographic and urographic findings were consistent with the diagnosis of Brunn's cyst
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| Discussion | | |
Brunn's cysts originate from the Brunn's nests which result from pinching off of the epithelial nests from urothelial buds.[3] In a study by Weiner et al., 89% of the specimens of Brunn's cysts and cystitis cystica contained Brunn's nests. In their report, none of the cysts involved the bladder neck, rather the involvement of ureters was common.[4]
Prostatic cysts are one of the differential diagnosis of a cystic lesion near the bladder neck. In comparison to a Brunn's cyst which is located at the bladder neck above the prostatic parenchyma, the prostatic cysts are intraparenchymal and originate from the posterior structures such as the utricle or the ejaculatory duct. Also, whereas the prostatic cysts are usually asymptomatic, the Brunn's cyst at the bladder neck presents with lower urinary tract symptoms (LUTS).[5]
Another important differential diagnosis is a ureterocele in an ectopic ureter. The ultrasonographic findings may be non-diagnostic and thus intravenous urography plays an important role in differentiating a ureterocele from the bladder neck cyst. Cystoscopy plays diagnostic as well as therapeutic role in the management of Brunn's cysts. Cystoscopy reveals a cystic lesion at the neck which can be managed by transuretheral deroofing and resection of the cyst in the same sitting.[5]
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
| References | | |
| 1. | Sailo SL, Sailo L. Brunn's cyst: A Rare cause of bladder outlet obstruction in a young man. Urol J 2015;12:2381.  [ PUBMED] |
| 2. | Grimsby GM, Tyson MD, Salevitz B, Smith ML, Castle EP. Bladder outlet obstruction secondary to a Brunn's cyst. Curr Urol 2012;6:50-2. [ PUBMED] |
| 3. | Goldstein AM, Fauer RB, Chinn M, Kaempf MJ. New concepts on formation of Brunn's nests and cysts in urinary tract mucosa. Urology 1978;11:513-7. [ PUBMED] |
| 4. | Wiener DP, Koss LG, Sablay B, Freed SZ. The prevalence and significance of Brunn's nests, cystitis cystica and squamous metaplasia in normal bladders. J Urol 1979;122:317-21. [ PUBMED] |
| 5. | Chang SG, Hwang IC, Lee JH, Park YK, Lim JW. Infravesical obstruction due to benign intraurethral prostatic cyst. J Korean Med Sci 2003;18:125-6. [ PUBMED] |
[Figure 1], [Figure 2]
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