Late Presentation of Posterior Urethral Valve with Giant Prostatic Utricle Cyst and Urethro-Ejaculatory Duct Reflux in an Adolescent Trisomy 21 Patient: Case Report

Prostatic utricle represents the caudal end of fused mullerian ducts. Untreated prostatic utricle pouch with urethro-ejaculatory duct reflux can lead to recurrent epididymo-orchitis and other complications. Recurrent urinary tract infections (UTI) may manifest in patients when it is associated with posterior urethral valve. A 13-year-old boy presented with recurrent urinary tract infections complicated by an anterior urethro-cutaneous fistula. On imaging, he was found to have posterior urethral valve, prostatic utricle cyst, and urethro-ejaculatory duct reflux. To the best of our knowledge, this is the first case report to describe the combination of these three findings in the same patient. Prostatic utricle cyst is a rare condition which should be considered in the differential of midline cysts of the lower male genitourinary tract. MCU/RGU should be performed in such cases to exclude urethro-ejaculatory duct reflux which may predispose to epididymo-orchitis. Early management of reflux by correcting the underlying anomaly will help prevent complications.