向井 伸哉, 須山 出穂, 須山 一穂, 呉 幹純, 藤野 淡人, 石橋 晃

Nobuya MUKAI, Izuho SUYAMA, Kazuho SUYAMA, Mikitoshi GO, Awato FUJINO, Akira ISHIBASHI

北里大学医学部泌尿器科学教室

Department of Urology, School of Medicine, Kitasato University

キーワード : Müllerian duct cyst, Transrectal ultrasonography

A 31-year-old male with intractable perineal pain who had been treated for chronic prostatitis for 5 years visited our clinic in November.
On rectal digital examination, a soft mass with tenderness was palpable in the prostate. Urinalysis, urine culture, and urography were unremarkable. Transrectal ultrasonogram (TRUS), however, showed a cystic lesion between the seminal vesicles infravesically toward the posterior aspect of the prostate. Magnetic Resonance Images (MRI) also demonstrated a cystic lesion in the midline portion infravesically.
The diagnosis of a Müllerian duct cyst was verified by ultrasonically guided transperineal needle aspiration, followed by a cystogram.
The cyst fluid contained no sperm and was sterile on culture.
After the fluid aspirated entirely, 100 mg of Minomycin was injected into the cyst.
The treatment was repeated once, and serial TRUS proved the therapy's effectiveness by demonstrating a gradual decrease in the size of the cyst. A late TRUS show no evidence of a recurrent cyst, and the patient is doing well.
The surgical exploration for diagnosis of a Müllerian duct cyst and open surgery for the treatment should be done in limited cases and in certain circumstances.
The role of Ultrasonography, CT, and MRI in the diagnosis of Müllerian duct cysts in generally accepted, though additional diagnostic modalities, including aspiration and examinations for the fluid of Müllerian duct cyst, are necessary to pinpoint the problem.
We have successfully treated a patient with Müllerian duct cyst by repeated needle aspirations followed by injections of antibiotics into the cyst under TRUS guidance alone.
No notable complication has been experienced by those treatments.
Furthermore, there has been no evidence of recurrent fluid collection within the cyst to date.
We conclude that TRUS should be the most beneficial modality in the diagnosis, treatment, and follow of Müllerian duct cyst.