Laparoscopic treatment of utricular cysts

In traditional open surgery several ways of approach have been advocated to access the retrourethral space and remove utriclular cyst (also called müllerian duct remnants, MDR): a) perineal; b) retropubic or sovrapubic extravesical; c) transvesical transtrigonal; d) transperitoneal; e) posterior sagittal transanorectal; f) anterior sagittal transanorectal (ASTRA); g) posterior perirectal or pararectal. [2,5,8,9] All these procedures are often technically challenging and have a potential risk of complications such as injury to pelvic nerve complex and anal sphincter, infections, incontinence and impotence; moreover, they require prolonged hospitalisation and cannot be completely resolving [6,7]. The use of laparoscopic technique obviates to these disadvantages because provides an optimal view, thanks to the imaging magnification, and permits to perform a fine dissection of MDR with an excellent exposition of all surrounding structure, with a minimal trauma on peritoneal cavity and a low incidence of postoperative adhesions. Mc Dougal [4] described in 1994 the use of laparoscopic approach to excise a MDR in a 48-year-old male patient with preservation of continence and potency. In 1998, we first successfully performed a laparoscopic removal of a MDR in a 15-year-old boy [3]. Successively we operated on five further boys with MDR In this chapter we present the laparoscopic procedure that we successfully performed in a series of six boys with MDR