Hypothesis / aims of study
Parameatal cysts (PMC) are considered rare and benign lesions. They are usually asymptomatic in childhood but may later present with pain during intercourse or distorted urinary stream. After reviewing the literature, most of the authors agreed surgical excision may bring good cosmetic result without recurrence. However, due to the nature of possible spontaneous regression in childhood, most of the patient’s family would choose active surveillance rather than surgical intervention. In this study, we shared our experiences for parameatal cyst.
Study design, materials and methods
7 cases were diagnosed with parameatal cysts at our hospital during the past 2 years, including 3 adults and 4 children. We retrospectively reviewed the medical record. Charts were reviewed to determine patient demographics, symptomatology, pathology, and treatment.
According to the record, all the children were asymptomatic and they were brought to hospital due to family preference. The onset of the cyst was noted at birth or within the first year of life in 4 patients. The adult came for help because of pain of the ruptured cyst, intercourse discomfort, bifurcation of urination, and cosmetic consideration. The cysts were consistently located either lateral
or ventral to the meatus. The size of the cysts in children were less in 10mm diameter, and the size of the cysts in adult were about 10mm diameter in the record. All four boys accepted simple aspiration and the lesion recurred within six months after the operation. We then performed the secondary simple aspiration. No more recurrence was noted during the next 1 year of follow up. All the adults underwent complete excision and the associated symptoms subsided. No recurrences or complications were encountered at the follow-up. The pathology results were available for all 3 adult patients. All of the specimens contained the type of epithelium. No malignancy was revealed.
Interpretation of results
Parameatal cysts are very rare benign lesions which are seen in boys, but they can also occur in infants, girls and adults. The cysts are usually small of about 1 cm in diameter. They occur on the lateral margin of the urethral meatus and at times, they can be bilateral. They may be congenital or they may appear spontaneously. In our cases, the lesions of the children were about less than 10mm in diameter and 3 of them had appeared spontaneously and one of them had be congenital. Diagnosis were incidental when cysts are asymptomatic in boy-patients. However, in adult, they may cause urinary retention, painful micturition, sexual intercourse, poor cosmesis, and distortion of urinary stream. When the cysts are traumatized, they may be bleeding, rupture or become infected source. The treatments of choice for such cysts are varied. However, fine needle aspiration, simple decapping, and marsupialization have also been reported in other study but recurrences are very common with these methods. In our cases; complete wide excision with total epithelium provide well cosmetics, no complication and no recurrence. For children, spontaneous regression may occur during childhood, so simple aspiration may also be considered as a treatment choice but may suffer the risk of recurrence. If the cyst does not resolve, a surgical intervention can be considered. In late childhood, spontaneous resolution occurs more rarely, hence, a surgical intervention can be recommended. In our opinion, complete excision of the cyst with total removal of the epithelium is required for treatment and prevention of recurrence.