Robotic excision of a large prostatic utricle cyst with microdissection testicular sperm extraction presenting as primary infertility: A case report.

INTRODUCTION AND

IMPORTANCE

Prostatic utricle cyst (PUC) is an anatomic anomaly resulting from a vestigial remnant of the Müllerian duct in the posterior urethra. Proper diagnosis is crucial, as its presentation can vary widely and can present with infertility. The aim of this article is to present a rare case of a large prostatic utricle cyst as a cause of primary infertility, surgically managed with robotic excision followed by microdissection testicular sperm extraction to achieve fertility.

CASE PRESENTATION: This is a case report of a 29-year-old male presenting with recurrent epididymo-orchitis and primary infertility. Imaging confirmed the presence of an enlarged PUC and was further managed as a case of obstructive azoospermia. Robotic surgery was done owing to its innovative approach in ensuring precise movements, improved anatomical visualization, and finer dissection into the deep pelvic cavity. Successful conception of a healthy offspring was achieved through one attempt of in vitro fertilization.

CLINICAL DISCUSSION: Large symptomatic prostatic utricle cysts are managed surgically, whether open, endoscopic, laparoscopic, or robotic. Robotic-assisted laparoscopic excision of prostatic utricle cysts offers many advantages in terms of surgical field exposure, highly improved surgical dexterity and precision, fewer intraoperative complications, and postoperative outcomes. Testicular sperm extraction after surgery is recommended in such cases if fertility is desired.

CONCLUSION

Robotic excision with microdissection testicular sperm extraction for sperm cryopreservation for future fertility is a feasible and promising option for the treatment of large symptomatic prostatic utricle cysts.