Symptomatic Müllerian Duct Cyst in a Male Adult: A Rare Case Report

Müllerian duct cyst is an uncommon congenital anomaly. It is usually small and asymptomatic. A rare case of this entity with symptoms of ejaculatory duct obstruction such as hematospermia and secondary infertility is presented here.
Case Report: A 39-year-old male presented with complaints of pain in the lower abdomen, dysuria, frequency, and hematospermia for the last 2 years. He also suffered from secondary infertility with a 9-year-old son. Imaging studies showed a large cystic midline lesion right behind the bladder and also bilateral dilated ejaculatory ducts. The patient underwent a transurethral drainage. The prostatic urethra was resected using a 26 Fr resection loop proximal to the verumontanum and a capacious cystic structure opened, and finally two dilated ejaculatory duct openings were seen. On follow-up, a significant improvement of symptoms and semen quality was achieved after surgery.
A high index of suspicion in using advanced imaging modalities is necessary for the diagnosis of this anomaly. Surgical excision of a Müllerian duct cyst may be performed depending on the size and location of the cyst and the presence of clinical symptoms. Transurethral de-roofing of the cyst is effective and safe for the treatment of small Müllerian duct cyst accompanied with ejaculatory duct obstruction.