Patient's question:
Recently, I've been experiencing pain in the urethra and a feeling of fullness in the perineum, specifically in the lower abdomen. The examination revealed a prostatic cyst. I would like to ask, is surgery mandatory for prostatic cysts?Doctor's answer:
Smaller and asymptomatic cysts may not require treatment, while larger cysts or symptomatic small cysts can be treated surgically through various approaches such as transurethral, extravesical, perineal, or transrectal routes. Poor exposure often leads to incomplete surgical resection, resulting in a high recurrence rate and frequent complications. When cysts are near the perineum, perineal approach surgery can easily cause erectile dysfunction (ED), so it should be used with caution in young patients. There have been reports of cyst puncture and aspiration under ultrasound guidance via the perineal or transrectal routes, followed by the injection of a coagulant, but recurrence is common. For cysts near the urethra-bladder junction or protruding into the bladder, transurethral surgery or transurethral resection can be used to remove most of the cyst's top part for adequate drainage. Laparoscopic cyst resection offers advantages such as clear tissue exposure, shorter operation time, reduced risk of pelvic tissue damage, minimal trauma, no need for fistula creation, and less bleeding, making it the preferred method for treating prostate cysts that protrude posteriorly into the urethra or into the bladder neck. For cysts near the urethra or protruding into the bladder, transurethral electroresection is the optimal surgical approach. However, in young patients, preserving the verumontanum is crucial for normal ejaculation. When a patient has persistent high fever, no significant improvement in urinary symptoms, urethral discharge, or difficulty defecating, prostate cysts should be considered. After confirming the diagnosis with ultrasound and other tests, treatment such as abscess incision and drainage or puncture drainage should be performed. Only after the abscess is completely eliminated will the above symptoms subside.