A Rare Case of Prostatic Utricle Cyst Causing Obstructive Azoospermia

Abstract

Male infertility is a concern affecting approximately 8% of couples worldwide, with ejaculatory duct obstruction contributing to about 5% of male infertility cases. Prostatic utricle cysts are a rare but surgically correctable cause of ejaculatory duct obstruction. While often asymptomatic, these cysts can manifest as azoospermia with low ejaculate volume, necessitating intervention for fertility restoration. We present the case of a 22-year-old newly married male with azoospermia and otherwise unremarkable medical history. Clinical examination revealed normal bilateral vas deferens and epididymis, along with low ejaculate volume. Testicular size, follicle-stimulating hormone, and testosterone levels were within the normal range. Transabdominal ultrasound uncovered a midline cystic structure within the prostate. Bilateral testicular fine-needle aspiration confirmed the presence of spermatozoa at various stages of development. The patient underwent urethroscopy, bilateral retrograde seminal vesiculography, and transurethral resection of the midline prostatic cyst. At 3 months, the follow-up revealed normal semen analysis. Transurethral resection of the roof of the midline prostatic cyst can effectively restore fertility in cases of ejaculatory duct obstruction. Precise resection technique is crucial to prevent damage to the urethral sphincter and subsequent incontinence. This approach offers a favorable prognosis for fertility restoration in patients with prostatic utricle cysts and associated azoospermia.