Objective To report our experience of laparoscopic excision of symptomatic
prostatic utricles in children.
Patients and methods Prostatic utricles were excised laparoscopically in fo
ur boys (mean age 6.3 years, range 1.5-17). Cysto-urethroscopy and cannulat
ion of the prostatic utricle was initially undertaken with a cystoscope tha
t was left in situ inside the prostatic utricle to facilitate subsequent id
entification and mobilization during the laparoscopic procedure. Laparoscop
y was conducted via a 5-mm port inserted through a supra-umbilical incision
, Two more 5 mm working ports were inserted at the right and left mid-abdom
en. The prostatic utricle was easily identified with the guidance of cystos
copic transillumination. Dissection was further facilitated by lifting and
counter-traction of the prostatic utricle using the indwelling cystoscope.
The prostatic utricle was completely mobilized and divided at its confluenc
e with the urethra using an ultrasonic scalpel.
Results Laparoscopic excision of the prostatic utricle was successful in al
l four patients. The urethral defect was closed by intracorporeal suturing
in three patients while the defect was small enough to be adequately closed
by ultrasonic coagulation in one. One patient also had a nonfunctioning dy
splastic kidney associated with an ectopic ureter joining into the prostati
c utricle, and underwent nephroureterectomy at the same setting. The mean (
range) operative duration was 148 (105-225) min, All four patients recovere
d uneventfully with no complications.
Conclusions Laparoscopic excision under cystoscopic guidance is effective f
or symptomatic prostatic utricles, offering a good surgical view and allowi
ng easy dissection in a deep and narrow pelvic cavity.