Do Parameatal Urethral Cysts in Children Need Surgical Excision?
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Updated: Sep 20, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Keiichiro Tanaka1, Nana Nakazawa-Tanaka1, Masahiko Urao1
1Department of Pediatric Surgery, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan.
Insights
Parameatal urethral cysts (PUCs) in boys smaller than 5 mm may resolve spontaneously. Larger or symptomatic PUCs often require surgical excision, especially when preferred by families.
Area of Science:
- Pediatric Urology
- Urogenital Abnormalities
Background:
- Parameatal urethral cysts (PUCs) are congenital anomalies affecting the male urethra.
- Understanding the natural history and management options for PUCs is crucial for pediatric urologists.
Purpose of the Study:
- To investigate the pathophysiology of parameatal urethral cysts (PUCs).
- To compare outcomes between surgical excision and spontaneous resolution in pediatric patients with PUCs.
Main Methods:
- Retrospective review of patients aged ≤15 years diagnosed with PUC.
- Analysis of patient demographics, symptoms, clinical course, and pathological findings.
- Comparison of outcomes based on initial management: observation versus surgical excision.
Main Results:
- 54 boys with PUC were analyzed; 70.4% underwent surgical excision, and 22.2% showed spontaneous resolution.
- PUCs ≥5 mm in diameter did not spontaneously resolve.
- Median PUC size was significantly larger in the surgical group (5 mm) compared to the spontaneous resolution group (1.5 mm).
Conclusions:
- Approximately 22% of PUCs demonstrate spontaneous resolution.
- PUCs <5 mm have a potential for spontaneous resolution, warranting observation for at least 5.5 months if asymptomatic.
- Symptomatic PUCs ≥5 mm are recommended for surgical excision, respecting family preference.
Objective:
To examine pathophysiology of parameatal urethral cyst (PUC) with comparison between the surgical excision group and the spontaneous resolution group.
Methods:
We retrospectively reviewed all patients diagnosed with PUC and aged ≤15 years. Initially, all the patients received observation without any treatment. The indication of surgical excision was family preference. The patients were analyzed according to their sex, age, symptoms, clinical course, and pathological examination findings.
Results:
Among the 54 boys visited our hospital for PUC. The median age at presentation was 35 (IQR: 12-50) months, including 7 (13.0%) neonates cases. In total, 38 (70.4%) patients were underwent surgical excision, 12 (22.2%) had spontaneous resolution during observation, 1 (1.9%) had observation without resolution, and 3 (5.6%) were lost to follow-up. The median size of PUC at the first visit was significantly larger in the surgical excision group (5 mm median, IQR 3-5) than in the spontaneous resolution group (1.5 mm median, IQR 1-2.5) (P <.0001). In this study, PUC ≥5 mm in diameter did not have spontaneous resolution.
Conclusion:
This is the largest study of PUC conducted at a single institute. This study indicated that 22% of PUCs had spontaneous resolution, and PUCs <5 mm had potential for spontaneous resolution. The results recommend an observation of at least 5.5 months for patients with asymptomatic PUC <5 mm. By contrast, we recommend the surgical excision for symptomatic PUC ≥5 mm according to the family preference.
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