Abnormal prostatic utricle configuration in hypospadias and intersex patients

A retrospective clinical trial was performed to evaluate the incidence, clinical characteristics, diagnosis and treatment methods of abnormal prostatic utricle configuration (APUC) in hypospadias and intersex patients. Forty-five hypospadias and 72 intersex patients in whom the configuration of prostatic utricle (PU) was evaluated by radiological and endoscopic investigations formed the study group out of 380 hypospadias and 160 intersex patients who were treated between 1975 and 1996. Enlargement of PU (EPU) was classified into four grades based on the radiological configuration. The term vagina masculina (VM) was used to define the presence of unregressed müllerian duct structures. The incidence of APUC (either enlarged PU: EPU or VM) was 13.3% (n = 6) and 16.6% (n = 12) in hypospadias and intersex patients, respectively. The incidence and grade of EPU increased significantly with the severity of hypospadias. Urinary infection, obstruction and enuresis were the most common symptoms in both groups. Medical treatment consisting of appropriate antibiotics associated with follow-up of the APUC by means of radiological and endoscopic investigations was carried out in 4 patients with Grade I EPU successfully. Surgical excision of the Grade II, III and/or VM through perineal (n = 5), transabdominal extravesical (n = 5) and perineal plus transabdominal extravesical (n = 3) approaches was done while one patient was lost for follow-up before treatment. We emphasize that surgical treatment of EPU and VM must aim at complete excision without damaging continence and sexual potency mechanisms. The selection of the surgical treatment method should be individualized according to the grade of APUC which must be defined by preoperative radiological and endoscopic investigations. The optimal surgical method is the one which allows the best visualization of the involved anatomy, facilitates accurate suture placement with complete removal of the EPU and VM and avoids inadvertent injury to the adjacent tissues. Guidance by urethral and utricular catheters is essential for safe and elegant dissection in all surgical methods.