Cystoscopic-assisted laparoscopic excision of prostatic utricle

Area of Science:

• Urology
• Pediatric Surgery
• Genetics

Background:

• Disorders of sex development (DSD) can present with complex anatomical abnormalities.
• Large prostatic utricles (PU) are rare congenital anomalies that can lead to recurrent infections and complications.
• Surgical management of PU remains challenging due to anatomical complexity and risk of nerve damage.

Purpose of the Study:

• To present a video demonstrating a cystoscopic-assisted laparoscopic technique for prostatic utricle (PU) resection.
• To highlight the advantages of a minimally invasive approach for PU excision.
• To offer a potentially safer and more effective surgical option for managing large PUs.

Main Methods:

• A 46XY patient with DSD, hypospadias, and recurrent epididymo-orchitis due to a large PU underwent cystoscopic-assisted laparoscopic excision.
• Micturating cystourethrogram (MCUG) was used to delineate the PU and its relationship with the bladder.
• Laparoscopic surgery provided enhanced visualization and magnification of the deep pelvic structures.

Main Results:

• The cystoscopic-assisted laparoscopic approach facilitated precise dissection and counter-traction.
• The procedure allowed for successful resection of the large prostatic utricle.
• This technique potentially reduces pelvic dissection and risk to pelvic nerves.

Conclusions:

• Cystoscopic-assisted laparoscopic excision is a promising technique for managing large prostatic utricles.
• This minimally invasive approach may offer reduced postoperative pain and scarring.
• Further studies are warranted to establish this technique as a standard of care for PU resection.