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Published on: August 14, 2019
The prostatic utricle: An under-recognized condition resulting in significant morbidity in boys with both hypospadias
Austin G Hester1, Stanley J Kogan1
1Department of Urology, Wake Forest University, Winston-Salem, NC, USA.
Insights
The prostatic utricle, a rare condition, can cause urinary issues in boys with hypospadias or normal genitalia. Early diagnosis and intervention are crucial for managing pediatric prostatic utricle morbidity.
Area of Science:
- Pediatric Urology
- Male Reproductive Health
- Congenital Anomalies
Background:
- Prostatic utricle presentations in children are infrequently documented.
- While often associated with hypospadias, its incidence and morbidity in boys with normal genitalia are poorly understood.
Purpose of the Study:
- To investigate the frequency and clinical significance of the prostatic utricle in pediatric patients.
- To compare the diagnostic approaches and outcomes in boys with hypospadias versus those with normal external genitalia presenting with lower urinary tract symptoms.
Main Methods:
- Retrospective review of 64 patients with hypospadias to assess diagnostic study frequency and utricle identification.
- Analysis of a subsequent cohort of 70 boys with hypospadias and 23 boys with normal genitalia who presented with lower urinary tract symptoms and were diagnosed with a prostatic utricle.
Main Results:
- In the initial hypospadias cohort, 9.4% had a prostatic utricle, with 50% requiring surgical excision.
- Boys with normal genitalia and a utricle exclusively presented with symptoms directly attributable to the anomaly, necessitating surgical intervention.
- Common presenting symptoms included voiding pain, hematuria, epididymitis, and urinary tract infections.
Conclusions:
- The prostatic utricle is a significant cause of morbidity in pediatric patients, irrespective of external genitalia status.
- Recommended investigations include endoscopic or radiological evaluation for boys with proximal hypospadias, cryptorchidism, or urinary symptoms.
- Cystoscopy is advised for boys with normal genitalia and unexplained lower urinary tract symptoms to rule out an unsuspected prostatic utricle.
Introduction:
Pediatric presentations of a prostatic utricle have received only scant attention. Though recognized with increased frequency in boys with hypospadias, little is described about their incidence and potential for morbidity in boys with normal external genitalia.
Methods:
We initially reviewed a cohort of 64 patients with hypospadias seen over a 3-year period to determine the frequency of investigative lower urinary tract studies and utricle identification. Children with disorders of sexual differentiation were excluded from this review. A subsequent group of 70 boys with hypospadias and 23 boys with normal external genitalia presenting with lower urinary tract symptoms (LUTS) who were found to have an unsuspected utricle were reviewed. This comparative group was investigated since symptomatology was the indication for evaluation, contrasting with those in the hypospadias group who were investigated because of hypospadias presence alone.
Results:
In our initial review of 64 patients only 24 (37.5%) underwent an investigative study and six (9.4%) had a utricle. Three (50%) required surgical excision, allowing their hypospadias repair to proceed. Results in the subsequent group with hypospadias confirmed these findings with increased rates of investigation and identification. The boys with normal external male genitalia all required surgery since symptoms were the result of the utricle alone. Penile pain with voiding, hematuria, epididymitis, and urinary infection were the most common causes for interventions.
Conclusions:
The prostatic utricle should be considered as a cause of morbidity in boys with both normal external genitalia and those with hypospadias. Endoscopic or radiological evaluation (see Figure) should be undertaken in all boys with proximal hypospadias, boys with hypospadias and associated cryptorchidism, and those with hypospadias with associated urinary symptoms. Boys with normal external genitalia with lower urinary tract symptoms not explained with imaging should undergo cystoscopy, as an unidentified unsuspected utricle may be the underlying cause.
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