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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 18  |  Issue : 3  |  Page : 234-236

Parameatal cyst: A report of five cases


1 Department of Paediatric Surgery, Dr. B. C. Roy Postgraduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
2 Department of Pediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
3 Department of Pathology, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India

Date of Web Publication7-Jun-2017

Correspondence Address:
Pankaj Halder
Saroda Palli, Panchanon Tala, Baruipur, Kolkata - 700 144, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.193009

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  Abstract 

The parameatal cyst (PMC) is a rare and benign lesion which occurs in newborn, children, or even in adults. We present five patients of PMC to discuss its embryology, clinical presentation, and the treatment along with a brief review of literature.

Keywords: Excision, marsupialization, parameatal, urethral


How to cite this article:
Halder P, Mandal KC, Kumar R, Mukhopadhyay M. Parameatal cyst: A report of five cases. Indian J Paediatr Dermatol 2017;18:234-6

How to cite this URL:
Halder P, Mandal KC, Kumar R, Mukhopadhyay M. Parameatal cyst: A report of five cases. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Sep 26];18:234-6. Available from: http://www.ijpd.in/text.asp?2017/18/3/234/193009


  Introduction Top


The parameatal cyst (PMC) was first described in 1956 by Thompson and Lantin. These cysts are usually asymptomatic, but in long-standing cases, they produce a variety of urinary symptoms, especially in adults.[1] Surgery is performed in children to restore the good cosmesis of the genitalia. Although needle aspiration, simple de-capping, and marsupialization have been reported, complete excision of the cyst is the treatment of choice. We present our experience of five cases of PMC.


  Case Report Top


Five patients presented with cystic swelling over the glans penis near the external urethral meatus. The clinical symptoms and the position of the cysts in relation to the meatal opening were not similar to each other [Table 1]. In all patients, there was no history of trauma or inflammation at the site of the cyst. The cysts were nontender. They were neither progressive nor regressive in nature. The diagnosis of PMC was made on clinical examination. There was no improvement or increase in the size of the cyst in our patients. Blood counts, blood chemistry, urine analysis, and urine culture were normal in all patients. All the five patients underwent complete surgical excision of the cyst under general anesthesia.
Table 1: Clinical spectrum of parameatal cysts (n=5)

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No communication with the urethra was demonstrated. Utmost care was taken to remove all the lining epithelium, and the edges were sutured with 6-0 absorbable suture. A Nelaton urethral catheter was placed for 48 h. The postoperative period was uneventful in all patients. Histology showed benign cyst with urothelial lining epithelium [Table 1]. There was no evidence of inflammation. Good cosmetic results were obtained in all patients [Figure 1] and [Figure 2], without meatal stenosis/stricture and urine flow problems. No recurrence was observed at 6 months of follow-up.
Figure 1: Pre-operative pictures of Para meatal cysts at different position (3o clock, 6o clock, 7o clock and 9o clock position)

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Figure 2: Post- operative pictures of Para meatal cyst at 7o clock position (Immediately after operation, after 48 hours, after 7 days and after 3 months)

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  Discussion Top


PMCs of the glans penis have been described under various diagnostic terms such as mucoid cyst, urethral cyst, and apocrine cystadenoma. It is more common in boys than in girls. Its pathogenesis is obscure till now. It is believed that it occurs as a result of inflammation, but it does not explain the etiology of congenital PMC.[2] Other postulations are occlusions of paraurethral ducts, presence of accessory male sex glands in the penile urethra, and inadvertent estrogenic stimulation.[3] The size of the cyst varies from 2 to 10 mm. It occurs on the lateral margin of the external urethral meatus. Unilateral cases of PMC are usually asymptomatic. Parents usually seek treatment for the poor cosmesis of the genitalia of their children. Sometimes, it develops on both sides of the meatus which produces a variety of symptoms such as dysuria, difficulty in urination, and acute retention.[4] Most of the PMCs in pediatric age group can be diagnosed by physical examination alone. In adults, a prolapsing ureterocele or a urethral duplication may present with a paraurethral swelling where full urological examination is necessary.[5] In our patients, physical examination alone was adequate to make the diagnosis. Apart from traumatic bleeding and infection, spontaneous rupture of the cyst may occur in the long-standing cases. Thus, management is initiated without any delay after the diagnosis. The management of choice for PMC is complete excision. However, needle aspiration, simple de-capping, and marsupialization have also been reported.[6] However, satisfactory cosmetic results may not be obtained with aspiration and marsupialization of the cyst.[7] We achieved very good cosmetic results with complete surgical excision of the cysts. The cyst wall lining varies according to the segment origin of the urethra of the lesion, and it may be by columnar, cuboidal, squamous, or transitional epithelium.[8] The lining epithelium does not have any role in the management and recurrences. In our patients, the cysts were lined by tall columnar, transitional, and pseudo-stratified epithelium. Recurrences are mostly related to spontaneous rupture, needle aspiration, simple de-capping, and marsupialization.


  Conclusion Top


Unilateral PMC does infrequently produce symptoms. Most of them seek a physician because of a poor cosmesis. Clinical examination is adequate to make diagnosis, and thorough urological investigations are unnecessary. Early surgical excision is imperative to prevent recurrence as well as to get good cosmetic results and to avoid unnecessary complications.

Acknowledgment

The authors thank Biswanath Mukhopadhyay, Ex Professor and Head (MS, M. Ch, FICS, FRCS [Edin], FRCS [Glas]) and Bidyut Debnath, Professor and Head (MS, M. Ch, DNB, FRCS [Ed]) for helping in conducting this study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Lal S, Agarwal A. Parameatal cyst: A presentation of rare case and review of literature. J Clin Diagn Res 2013;7:1757-8.  Back to cited text no. 1
    
2.
Lorette G, Machet MC, Maruani A. Parameatal cyst in a 4-year-old boy. Eur J Pediatr 2013;172:1701.  Back to cited text no. 2
[PUBMED]    
3.
Neeli SI, Patne P, Kadli S, Hiremath S. Parameatal cyst of glans penis. J Sci Soc 2012;39:45-6.  Back to cited text no. 3
  [Full text]  
4.
Aggarwal K, Gupta S, Jain VK, Goel A. Parameatal urethral cyst. Indian J Dermatol Venereol Leprol 2008;74:430.  Back to cited text no. 4
  [Full text]  
5.
Lantin PM, Thompson IM. Parameatal cysts of the glans penis. J Urol 1956;76:753-5.  Back to cited text no. 5
    
6.
Yoshida K, Nakame Y, Negishi T. Parameatal urethral cysts. Urology 1985;26:490-1.  Back to cited text no. 6
    
7.
Ceylan H, Ozokutan BH, Karakök M, Buyukbese S. Paraurethral cyst: Is conservative management always appropriate? Eur J Pediatr Surg 2002;12:212-4.  Back to cited text no. 7
    
8.
Oka M, Nakashima K, Sakoda R. Congenital parameatal urethral cyst in the male. Br J Urol 1978;50:340-1.  Back to cited text no. 8
    


    Figures

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    Tables

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