title: Surgical technique: utriculus masculinum excision by a laparoscopic-cystoscopic approach.
abstract: OBJECTIVE
  A utriculus masculinum is encountered in 12% of hypospadias. However, patients rarely present with symptoms, such as post-void incontinence or infection. We describe a combined laparoscopic-cystoscopic approach to overcome the challenge posed by the location of the utriculus deep within the pelvis and to accurately identify the confluence of the utriculus with the urethra.
  
  
  METHODS
  A 12-year-old boy with Williams syndrome and previous hypospadias surgery presented with new-onset progressive day-time incontinence. Investigations (cystoscopy, urodynamics, MCUG) demonstrated a normal caliber urethra and the incontinence to result from a large utriculus masculinum. This video demonstrates the surgical technique: simultaneous utriculoscopy enabled the dome of the utriculus to be identified, laparoscopic dissection to progress under guidance of transillumination, and the urethral-utricular convergence to be clarified.
  
  
  RESULTS
  Histology demonstrated an inflamed utriculus with squamous metaplasia and cystitis glandularis. Symptoms resolved post-operatively and at 4 months follow-up, the patient remains dry by day.
  
  
  CONCLUSIONS
  A utriculus masculinum rarely requires excision. A combined laparoscopic-cystoscopic approach facilitates the delineation of the utriculus and allows its confluence to the urethra to be accurately determined.
authors: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
authors: Francisca
authors: F
authors: Yankovic
authors: Maria Grazia
authors: MG
authors: Scuderi
authors: Naima
authors: N
authors: Smeulders
mesh_terms: D002648:Child; D003558:Cystoscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D014549:Urinary Incontinence / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*