Laparoscopic Resection of Prostatic Utricle with Cystoscopic Guide: Report of Two Cases

Prostatic utricle (PU) is a Müllerian duct remnant frequently associated with proximal hypospadias and disorders of sex development (DSD). Although often asymptomatic, enlargement may cause recurrent urinary tract infections, post-void dribbling, urinary obstruction, or epididymo-orchitis, requiring surgical management. We report two pediatric cases of symptomatic Grade III PU managed with laparoscopic resection under cystoscopic guidance. The first case involved a 14-year-old male with SRY-negative 46XX DSD, left ovotestis, right scrotal testicle, and perineal hypospadias who developed recurrent urinary tract infections and post-void dribbling following staged hypospadias repair. Cystoscopy revealed a large PU communicating with the urethra. Laparoscopic excision was successfully completed with cystoscopic transillumination guidance and uneventful recovery. The second case involved a 9-month-old 46XY infant with DSD, non-palpable gonads, and hypospadic phallus. Diagnostic laparoscopy and cystoscopy identified intra-abdominal testes and a large Grade III PU. Laparoscopic resection combined with orchidopexy was attempted; however, due to bleeding and utricle size, conversion to laparotomy was required. Postoperatively, the patient developed voiding difficulties, which are currently under evaluation. Laparoscopic excision with cystoscopic guidance provides excellent visualization and safe dissection of deep pelvic structures. Nevertheless, large or complex utricles may require open conversion, emphasizing the need for individualized surgical planning.