Uncommon onset of lower urinary tract symptoms in a young adult: The impact of a large utricle cyst in a young adult

Abstract

Lower urinary tract symptoms (LUTS) in young adults are uncommon, making diagnosis difficult. This report describes the case of a young adult with no medical history who developed LUTS, which included urgency, nocturia, dysuria, and pelvic pain that lasted six months. The absence of fever or infectious symptoms raised concerns about atypical etiologies. Comprehensive testing, including bacterial urine and sperm screening, ruled out an infectious cause. Imaging indicated that the underlying cause was a prostatic utricle cyst, which is an embryological remnant that goes unnoticed in many cases but may cause symptoms when it is large. The successful endoscopic excision of the cyst resulted in total discomfort relief.

1 Introduction

Lower urinary tract symptoms (LUTS) encompass a range of symptoms. Commonly observed in older populations, LUTS typically include urgency, frequency, nocturia, and weak urine flow. While benign prostatic hyperplasia (BPH) is often implicated in older men, the occurrence of LUTS in younger males presents a diagnosis and management challenge for clinicians.

Irritative storage symptoms are more common than obstructive symptoms. Prostatitis is one of the most common infectious causes; however, urethral strictures and neurogenic bladder dysfunction also play a role in this clinical picture.

The rarity of LUTS in young adults needs a thorough examination to detect rare underlying problems that might otherwise be neglected, such as utricle cysts. The implications of LUTS in younger men can lead to significant discomfort, emotional distress, and impact social interactions. Ultimately, understanding the unique presentation of LUTS in young adults is essential for ensuring appropriate management and improving patient outcomes.

2 Case presentation

A 33-year-old patient with no particular medical history and a chronic smoker. Presented with lower urinary tract symptoms (LUTs) for 6 months without fever or signs suggesting a lower urinary tract infection. The patient mainly complained of urgency, nocturia, dysuria, and pelvic pain. The clinical examination of the pelvis and external genital organs was unremarkable, and the rectal examination was mildly painful. The flowmetry revealed a suboptimal Qmax of 12 mL.

The cytobacteriological study of the urine, as well as a PCR, did not find any pathogenic agents or sexually transmitted disease germs. In imaging, the ultrasound diagnosed a utricular cyst ( Fig. 1 ), which was then better characterized by pelvic MRI ( Fig. 2 ). On the MRI, a well-defined, rounded formation was observed in the right paramedian region of the posterior part of the prostatic base, with a pure T2 hyperintensity and T1 hypointensity not enhanced after injection, communicating with the urethra, consistent with a utricular cyst measuring 20 x 27 x 23 mm ( Fig. 2 ).

An endoscopic resection of the cyst was proposed subsequently. Resection of the cyst’s anterior wall was conducted while preserving the bladder neck and the external sphincter, resulting in the evacuation of a yellowish liquid, which completely resolved the lower urinary tract symptoms ( Fig. 3 ).