Pediatric Prostatic Utricle Cyst

Etiology: Area of focal dilation in prostatic utricle in males at level of verumontanum
Imaging: Midline cystic mass usually less than 1 centimeter in size that does not extend above prostate
DDX: Mullerian duct cyst – can arise anywhere along path of Mullerian duct regression from scrotum to utricle, are usually larger than prostatic utricle cyst, usually extend above prostate gland, usually detected in third and fourth decades of life, have no associations
Complications: May become infected
Treatment:
Clinical:
— Usually detected in first two decades of life
— Present as pelvic mass or obstructive urinary tract symptoms or hematuria or post-void dribbling due to urine pooling in cyst
— Associated with hypospadias and cryptorchidism, unilateral renal agenesis, anorectal malformation

Radiology Cases of Prostatic Utricle Cyst

VCUG of prostatic utricle in hypospadias — AP (above) and lateral (below) images from a voiding cystourethrogram shows a large oval structure posterior to the posterior urethra that fills with contrast during voiding and which represents a large prostatic utricle.

VCUG of prostatic utricle cyst — Lateral image from early in a VCUG exam (left) shows the catheter in a cystic structure that is posterior to the posterior urethra which has a thin line of contrast in it. Lateral image from later in the study during voiding (right) shows the clear communication between the posterior urethra and the cystic structure posterior to it.

CT of prostatic utricle cyst — Axial (above) and sagittal (below) CT with contrast of the abdomen show a round, thin-walled, low density structure posterior to the bladder and anterior to the rectum. On a subsequent voiding cytourethrogram exam (not provided) the structure did not fill with contrast.