Management of müllerian duct remnants

To describe the presentation and radiologic investigation of 6 patients who had persistent müllerian duct remnants (MDRs) in association with severe hypospadias and to review the long-term results of surgical management using the transtrigonal approach.

The hospital records of 6 patients who had MDRs and who underwent transvesical transtrigonal excision were reviewed and long-term assessment of urinary control and continence was made by interview.

One patient presented in the newborn period with clinically palpable MDRs and five others escaped detection until after the hypospadias repair, despite ultrasonography of the pelvis specifically looking for MDRs. All had undescended testis with severe hypospadias. The karyotype was 45XO/46XY in five and 46XY in one. The most consistently useful examinations were voiding cystourethrography and magnetic resonance imaging. The excision was transtrigonal in each case. Early or late postoperative complications were not encountered in any of our patients. Gonadal histologic examination showed streak gonad in four and a dysgenetic testis in one. Histopathologic examination showed rudimentary uterus and fallopian tubes in 4 patients and a cystic structure lined with squamous and columnar epithelium in 2 patients. No areas of metaplasia were noted. Bladder emptying was normal after surgery.

Ultrasound examination alone is not always sufficient to diagnose MDRs, which may be responsible for symptoms after hypospadias surgery. The transtrigonal approach provided excellent visualization and access to MDRs and prostatic urethra.