Adult mullerian duct or utricle cyst: Clinical significance and therapeutic management of 65 cases
Adult mullerian duct or utricle cyst: Clinical significance and therapeutic management of 65 cases
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DOI：
10.1016/s0022-5347(05)65190-7
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发表时间：
2002-04-01
影响因子：
6.6
通讯作者：
de Leval, J
中科院分区：
文献类型：
--
作者：
Coppens, L;Bonnet, P;de Leval, J
目的：我们定义成人苗勒管囊肿的勘探和治疗的指南。材料和方法：从1988年1月至1999年9月的诊断为前列腺椭圆囊扩大65成人经直肠超声检查结果的基础上。超声诊断标准，以确定简单和复杂的囊肿进行了详细说明。我们回顾了其临床表现、诊断方式、侵入性手术的适应证和术后结果。常见临床表现为血精40%，其他射精障碍20%，复发性睾丸或盆腔疼痛33%，下尿路刺激症状25%，下尿路感染18.5%，男性不育占12%，偶然发现占18.5%。囊肿大小不影响侵入性手术的适应症，仅在65例患者中的27例（41.5%）中进行侵入性手术，以治疗28%的致残症状和5%的阻塞性不孕症，并在6%的经直肠超声检查复杂囊肿。这些手术包括9例经会阴或经直肠穿刺，12例单纯内镜下椭圆囊鼻道切开术和6例大型造袋术。尽管超声心动图复发是常规，但仅用囊肿穿刺治疗的患者中有一半完全和持续治愈。内窥镜手术肯定改善或治愈82%的患者在平均随访51个月，在此期间，既不早期也不晚期并发症noted.Conclusions：由于近60%的成年人诊断为苗勒管囊肿没有经历任何囊肿相关的症状或射精生育障碍，我们建议调查和/或治疗应只做有症状或不育患者。
Purpose: We define guidelines for the exploration and treatment of adult mullerian duct cysts.Materials and Methods: From January 1988 through September 1999 a diagnosis of enlarged prostatic utricle was made in 65 adults based on transrectal ultrasound findings. Echographic criteria to define simple versus complicated cysts were detailed. We reviewed the clinical presentation, diagnostic modalities, indications for invasive procedures and postoperative outcome.Results: The usual clinical presentations were hematospermia in 40% of cases, other ejaculatory disturbances in 20%, recurrent testicular or pelviperineal pain in 33%, lower urinary tract irritation symptoms in 25%, lower urinary tract infection in 18.5%, male infertility in 12% and incidental finding in 18.5%. Cyst dimensions did not influence the indication for invasive procedures, which were performed in only 27 of the 65 patients (41.5%) to treat disabling symptoms in 28% and obstructive infertility in 5%, and investigate complicated cysts on transrectal ultrasound in 6%. These procedures included transperineal or transrectal puncture in 9 patients, simple endoscopic section of the utricle meatus in 12 and large marsupialisation in 6. Complete and sustained cure was noted in half of the patients treated with cyst puncture only, although echographic relapse was the rule. Endoscopic procedures definitely improved or cured 82% of the patients at a mean followup of 51 months, during which neither early nor late complications were noted.Conclusions: Since almost 60% of adults diagnosed with a mullerian duct cyst did not experience any cyst related symptoms or ejaculatory-fertility impairment, we recommend that investigation and/or treatment should only be done in symptomatic or infertile patients.