Utriculus Dilatation 1 (Voiding Disorder/Posterior Urethral Valves)

mikt_6a_n.jpg: View of the ventral side of a penis in a 4-month-old infant in whom the orifice of the urethra lies between the two halves of the scrotum. Photograph made prior to surgery of bilateral inguinal hernia and cryptorchidism. mikt_6b_n.jpg: External genitals after the reconstruction of the urethra in pre-schoolage; so far, the external genitals appear normal. mikt_6c_n.jpg: Following bilateral epididymitis and recurrent voiding disorder with dysuria and sudden stop of micturition, additional examinations were performed. During urethroscopy a cavity was visible starting from the posterior urethra; after introducing a ureter and balloon catheter and injection of contrast, a cavity became visible combined with a tube-like structure and a dilatation at its end. mikt_6d_n.jpg: Laparotomy with view of the uterus stretched by stay-sutures. The bladder is covered by a broad retractor and displaced forward. mikt_6e_n.jpg: After the excision of this 10 cm long structure, the voiding disorder disappeared. At the bottom there are rudimentary Fallopian tubes, at the top the vagina. mikt_6a_n.jpg to mikt_6e_n.jpg: The diagnosis is a cyst of the utricle which was increasing in size due to a postoperative stenosis between the original urethra and the reconstructed distal urethra, and due to a persistent vagina and uterus; this utricle cyst has led to the described voiding disorder by compression of the bladder neck from the outside. In severe types of hypospadias a prostatic utricle of recognizable size is present in a high percentage, either as an isolated utricle cyst or combined with persistent Mullerian structures as in the presented case due to a lack of anti-Mullerian hormone. The case illustrates the necessity of performing a VCUG in severe types of hypospadias to exclude a utricle, and to excise the utricle if present prior to the reconstruction of the urethra.