1Case:7 y/ mild pain+stream deflection+dysuria for more than a year. There is a nearly tense cystic lesion+ mild tenderness. What's this? What should we do?
Did you do an ultrasound to see whether structure of the cystic lesion is regular, basement membrane intact etc. ? If you have a pathology available, it shouldn't be an issue to punctuate the cyst and send to them for cytology of the fluid part and histology of the solid components. Just from the picture one could just give guesses based on frequency of occurrence but it's not possible to give a definite diagnosis; histological examination is required.
Dx:parameatal cyst
Rx: Excision
Pathology: Benign
Patient after Rx: Symptom free
By aspiration it will recur.
Http://www.ncbi.nlm.nih.gov/pubmed?term=median%20raphe%20cyst%20parameatal
It seems to be parameatal cyst,Excision is the treatment of choice.
Agree its most likely a parameatal cyst. Excision is the standard treatment of choice. In addition do calibrate the meatus and make sure there is no meatal stenosis to avoid a second surgery at later date.
Oh forgot, Ultrasound KUB for screening purpose in addition to urine microscopy just to complete baseline investigations.
I am surprised child has not undergone any treatment so far. This most probably is a parmeatal cyst. Strong likelihood of associated meatal stenosis. IF USG kub is normal I would go ahead with surgery: Meatal Calibration after excising cyst with meatoplasty. I would do a cysto-urethroscopy for complete evaluation of lower urinary tract.
Pls go ahead with same. May send the cyst for histology, but has no bearing on outcome.
Dear Jahoorahmad
There has not been any associated anomaly mentioned accompanying parameatal cyst. Indeed voiding deflection is due to cyst without any other symptom. So Just focusing on the cyst treatment, seems to be reasonable.
Dear Jahoorahmad
He has been treated before creating this topic. I put this case for challenge.
Yes,I excised it plus meatoplasty . The pathology was benign (cuboidal ) . Now, He voids comfortable.
I am looking forward your rare or challenging cases.
Maybe a parameatal cyst and excision will be the best choice if possible otherwise unroofing
Acutally it seems a parameatal cyst so excision is the only choice line of treatment with meatoplasty . follow up is mandatory to avoid meatal stenosis. Not forget to do pathological examination of the excised cyst
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