- •Preface
- •Acknowledgments
- •Contents
- •1.1 Introduction
- •1.2 Normal Embryology
- •1.3 Abnormalities of the Kidney
- •1.3.1 Renal Agenesis
- •1.3.2 Renal Hypoplasia
- •1.3.3 Supernumerary Kidneys
- •1.3.5 Polycystic Kidney Disease
- •1.3.6 Simple (Solitary) Renal Cyst
- •1.3.7 Renal Fusion and Renal Ectopia
- •1.3.8 Horseshoe Kidney
- •1.3.9 Crossed Fused Renal Ectopia
- •1.4 Abnormalities of the Ureter
- •1.5 Abnormalities of the Bladder
- •1.6 Abnormalities of the Penis and Urethra in Males
- •1.7 Abnormalities of Female External Genitalia
- •Further Reading
- •2.1 Introduction
- •2.2 Pathophysiology
- •2.3 Etiology of Hydronephrosis
- •2.5 Clinical Features
- •2.6 Investigations and Diagnosis
- •2.7 Treatment
- •2.8 Antenatal Hydronephrosis
- •Further Reading
- •3.1 Introduction
- •3.2 Embryology
- •3.3 Pathophysiology
- •3.4 Etiology of PUJ Obstruction
- •3.5 Clinical Features
- •3.6 Diagnosis and Investigations
- •3.7 Management of Newborns with PUJ Obstruction
- •3.8 Treatment
- •3.9 Post-operative Complications and Follow-Up
- •Further Reading
- •4: Renal Tumors in Children
- •4.1 Introduction
- •4.2 Wilms’ Tumor
- •4.2.1 Introduction
- •4.2.2 Etiology
- •4.2.3 Histopathology
- •4.2.4 Nephroblastomatosis
- •4.2.5 Clinical Features
- •4.2.6 Risk Factors for Wilms’ Tumor
- •4.2.7 Staging of Wilms Tumor
- •4.2.8 Investigations
- •4.2.9 Prognosis and Complications of Wilms Tumor
- •4.2.10 Surgical Considerations
- •4.2.11 Surgical Complications
- •4.2.12 Prognosis and Outcome
- •4.2.13 Extrarenal Wilms’ Tumors
- •4.3 Mesoblastic Nephroma
- •4.3.1 Introduction
- •4.3.3 Epidemiology
- •4.3.5 Clinical Features
- •4.3.6 Investigations
- •4.3.7 Treatment and Prognosis
- •4.4 Clear Cell Sarcoma of the Kidney (CCSK)
- •4.4.1 Introduction
- •4.4.2 Pathophysiology
- •4.4.3 Clinical Features
- •4.4.4 Investigations
- •4.4.5 Histopathology
- •4.4.6 Treatment
- •4.4.7 Prognosis
- •4.5 Malignant Rhabdoid Tumor of the Kidney
- •4.5.1 Introduction
- •4.5.2 Etiology and Pathophysiology
- •4.5.3 Histologic Findings
- •4.5.4 Clinical Features
- •4.5.5 Investigations and Diagnosis
- •4.5.6 Treatment and Outcome
- •4.5.7 Mortality/Morbidity
- •4.6 Renal Cell Carcinoma in Children
- •4.6.1 Introduction
- •4.6.2 Histopathology
- •4.6.4 Staging
- •4.6.5 Clinical Features
- •4.6.6 Investigations
- •4.6.7 Management
- •4.6.8 Prognosis
- •4.7 Angiomyolipoma of the Kidney
- •4.7.1 Introduction
- •4.7.2 Histopathology
- •4.7.4 Clinical Features
- •4.7.5 Investigations
- •4.7.6 Treatment and Prognosis
- •4.8 Renal Lymphoma
- •4.8.1 Introduction
- •4.8.2 Etiology and Pathogenesis
- •4.8.3 Diagnosis
- •4.8.4 Clinical Features
- •4.8.5 Treatment and Prognosis
- •4.9 Ossifying Renal Tumor of Infancy
- •4.10 Metanephric Adenoma
- •4.10.1 Introduction
- •4.10.2 Histopathology
- •4.10.3 Diagnosis
- •4.10.4 Clinical Features
- •4.10.5 Treatment
- •4.11 Multilocular Cystic Renal Tumor
- •Further Reading
- •Wilms’ Tumor
- •Mesoblastic Nephroma
- •Renal Cell Carcinoma in Children
- •Angiomyolipoma of the Kidney
- •Renal Lymphoma
- •Ossifying Renal Tumor of Infancy
- •Metanephric Adenoma
- •Multilocular Cystic Renal Tumor
- •5.1 Introduction
- •5.2 Embryology
- •5.4 Histologic Findings
- •5.7 Associated Anomalies
- •5.8 Clinical Features
- •5.9 Investigations
- •5.10 Treatment
- •Further Reading
- •6: Congenital Ureteral Anomalies
- •6.1 Etiology
- •6.2 Clinical Features
- •6.3 Investigations and Diagnosis
- •6.4 Duplex (Duplicated) System
- •6.4.1 Introduction
- •6.4.3 Clinical Features
- •6.4.4 Investigations
- •6.4.5 Treatment and Prognosis
- •6.5 Ectopic Ureter
- •6.5.1 Introduction
- •6.5.3 Clinical Features
- •6.5.4 Diagnosis
- •6.5.5 Surgical Treatment
- •6.6 Ureterocele
- •6.6.1 Introduction
- •6.6.3 Clinical Features
- •6.6.4 Investigations and Diagnosis
- •6.6.5 Treatment
- •6.6.5.1 Surgical Interventions
- •6.8 Mega Ureter
- •Further Reading
- •7: Congenital Megaureter
- •7.1 Introduction
- •7.3 Etiology and Pathophysiology
- •7.4 Clinical Presentation
- •7.5 Investigations and Diagnosis
- •7.6 Treatment and Prognosis
- •7.7 Complications
- •Further Reading
- •8.1 Introduction
- •8.2 Pathophysiology
- •8.4 Etiology of VUR
- •8.5 Clinical Features
- •8.6 Investigations
- •8.7 Management
- •8.7.1 Medical Treatment of VUR
- •8.7.2 Antibiotics Used for Prophylaxis
- •8.7.3 Anticholinergics
- •8.7.4 Surveillance
- •8.8 Surgical Therapy of VUR
- •8.8.1 Indications for Surgical Interventions
- •8.8.2 Indications for Surgical Interventions Based on Age at Diagnosis and the Presence or Absence of Renal Lesions
- •8.8.3 Endoscopic Injection
- •8.8.4 Surgical Management
- •8.9 Mortality/Morbidity
- •Further Reading
- •9: Pediatric Urolithiasis
- •9.1 Introduction
- •9.2 Etiology
- •9.4 Clinical Features
- •9.5 Investigations
- •9.6 Complications of Urolithiasis
- •9.7 Management
- •Further Reading
- •10.1 Introduction
- •10.2 Embryology of Persistent Müllerian Duct Syndrome
- •10.3 Etiology and Inheritance of PMDS
- •10.5 Clinical Features
- •10.6 Treatment
- •10.7 Prognosis
- •Further Reading
- •11.1 Introduction
- •11.2 Physiology and Bladder Function
- •11.2.1 Micturition
- •11.3 Pathophysiological Changes of NBSD
- •11.4 Etiology and Clinical Features
- •11.5 Investigations and Diagnosis
- •11.7 Management
- •11.8 Clean Intermittent Catheterization
- •11.9 Anticholinergics
- •11.10 Botulinum Toxin Type A
- •11.11 Tricyclic Antidepressant Drugs
- •11.12 Surgical Management
- •Further Reading
- •12.1 Introduction
- •12.2 Etiology
- •12.3 Pathophysiology
- •12.4 Clinical Features
- •12.5 Investigations and Diagnosis
- •12.6 Management
- •Further Reading
- •13.1 Introduction
- •13.2 Embryology
- •13.3 Epispadias
- •13.3.1 Introduction
- •13.3.2 Etiology
- •13.3.4 Treatment
- •13.3.6 Female Epispadias
- •13.3.7 Surgical Repair of Female Epispadias
- •13.3.8 Prognosis
- •13.4 Bladder Exstrophy
- •13.4.1 Introduction
- •13.4.2 Associated Anomalies
- •13.4.3 Principles of Surgical Management of Bladder Exstrophy
- •13.4.4 Evaluation and Management
- •13.5 Cloacal Exstrophy
- •13.5.1 Introduction
- •13.5.2 Skeletal Changes in Cloacal Exstrophy
- •13.5.3 Etiology and Pathogenesis
- •13.5.4 Prenatal Diagnosis
- •13.5.5 Associated Anomalies
- •13.5.8 Surgical Reconstruction
- •13.5.9 Management of Urinary Incontinence
- •13.5.10 Prognosis
- •13.5.11 Complications
- •Further Reading
- •14.1 Introduction
- •14.2 Etiology
- •14.3 Clinical Features
- •14.4 Associated Anomalies
- •14.5 Diagnosis
- •14.6 Treatment and Prognosis
- •Further Reading
- •15: Cloacal Anomalies
- •15.1 Introduction
- •15.2 Associated Anomalies
- •15.4 Clinical Features
- •15.5 Investigations
- •Further Reading
- •16: Urachal Remnants
- •16.1 Introduction
- •16.2 Embryology
- •16.4 Clinical Features
- •16.5 Tumors and Urachal Remnants
- •16.6 Management
- •Further Reading
- •17: Inguinal Hernias and Hydroceles
- •17.1 Introduction
- •17.2 Inguinal Hernia
- •17.2.1 Incidence
- •17.2.2 Etiology
- •17.2.3 Clinical Features
- •17.2.4 Variants of Hernia
- •17.2.6 Treatment
- •17.2.7 Complications of Inguinal Herniotomy
- •17.3 Hydrocele
- •17.3.1 Embryology
- •17.3.3 Treatment
- •Further Reading
- •18: Cloacal Exstrophy
- •18.1 Introduction
- •18.2 Etiology and Pathogenesis
- •18.3 Associated Anomalies
- •18.4 Clinical Features and Management
- •Further Reading
- •19: Posterior Urethral Valve
- •19.1 Introduction
- •19.2 Embryology
- •19.3 Pathophysiology
- •19.5 Clinical Features
- •19.6 Investigations and Diagnosis
- •19.7 Management
- •19.8 Medications Used in Patients with PUV
- •19.10 Long-Term Outcomes
- •19.10.3 Bladder Dysfunction
- •19.10.4 Renal Transplantation
- •19.10.5 Fertility
- •Further Reading
- •20.1 Introduction
- •20.2 Embryology
- •20.4 Clinical Features
- •20.5 Investigations
- •20.6 Treatment
- •20.7 The Müllerian Duct Cyst
- •Further Reading
- •21: Hypospadias
- •21.1 Introduction
- •21.2 Effects of Hypospadias
- •21.3 Embryology
- •21.4 Etiology of Hypospadias
- •21.5 Associated Anomalies
- •21.7 Clinical Features of Hypospadias
- •21.8 Treatment
- •21.9 Urinary Diversion
- •21.10 Postoperative Complications
- •Further Reading
- •22: Male Circumcision
- •22.1 Introduction
- •22.2 Anatomy and Pathophysiology
- •22.3 History of Circumcision
- •22.4 Pain Management
- •22.5 Indications for Circumcision
- •22.6 Contraindications to Circumcision
- •22.7 Surgical Procedure
- •22.8 Complications of Circumcision
- •Further Reading
- •23: Priapism in Children
- •23.1 Introduction
- •23.2 Pathophysiology
- •23.3 Etiology
- •23.5 Clinical Features
- •23.6 Investigations
- •23.7 Management
- •23.8 Prognosis
- •23.9 Priapism and Sickle Cell Disease
- •23.9.1 Introduction
- •23.9.2 Epidemiology
- •23.9.4 Pathophysiology
- •23.9.5 Clinical Features
- •23.9.6 Treatment
- •23.9.7 Prevention of Stuttering Priapism
- •23.9.8 Complications of Priapism and Prognosis
- •Further Reading
- •24.1 Introduction
- •24.2 Embryology and Normal Testicular Development and Descent
- •24.4 Causes of Undescended Testes and Risk Factors
- •24.5 Histopathology
- •24.7 Clinical Features and Diagnosis
- •24.8 Treatment
- •24.8.1 Success of Surgical Treatment
- •24.9 Complications of Orchidopexy
- •24.10 Infertility and Undescended Testes
- •24.11 Undescended Testes and the Risk of Cancer
- •Further Reading
- •25: Varicocele
- •25.1 Introduction
- •25.2 Etiology
- •25.3 Pathophysiology
- •25.4 Grading of Varicoceles
- •25.5 Clinical Features
- •25.6 Diagnosis
- •25.7 Treatment
- •25.8 Postoperative Complications
- •25.9 Prognosis
- •Further Reading
- •26.1 Introduction
- •26.2 Etiology and Risk Factors
- •26.3 Diagnosis
- •26.4 Intermittent Testicular Torsion
- •26.6 Effects of Testicular Torsion
- •26.7 Clinical Features
- •26.8 Treatment
- •26.9.1 Introduction
- •26.9.2 Etiology of Extravaginal Torsion
- •26.9.3 Clinical Features
- •26.9.4 Treatment
- •26.10 Torsion of the Testicular or Epididymal Appendage
- •26.10.1 Introduction
- •26.10.2 Embryology
- •26.10.3 Clinical Features
- •26.10.4 Investigations and Treatment
- •Further Reading
- •27: Testicular Tumors in Children
- •27.1 Introduction
- •27.4 Etiology of Testicular Tumors
- •27.5 Clinical Features
- •27.6 Staging
- •27.6.1 Regional Lymph Node Staging
- •27.7 Investigations
- •27.8 Treatment
- •27.9 Yolk Sac Tumor
- •27.10 Teratoma
- •27.11 Mixed Germ Cell Tumor
- •27.12 Stromal Tumors
- •27.13 Simple Testicular Cyst
- •27.14 Epidermoid Cysts
- •27.15 Testicular Microlithiasis (TM)
- •27.16 Gonadoblastoma
- •27.17 Cystic Dysplasia of the Testes
- •27.18 Leukemia and Lymphoma
- •27.19 Paratesticular Rhabdomyosarcoma
- •27.20 Prognosis and Outcome
- •Further Reading
- •28: Splenogonadal Fusion
- •28.1 Introduction
- •28.2 Etiology
- •28.4 Associated Anomalies
- •28.5 Clinical Features
- •28.6 Investigations
- •28.7 Treatment
- •Further Reading
- •29: Acute Scrotum
- •29.1 Introduction
- •29.2 Torsion of Testes
- •29.2.1 Introduction
- •29.2.3 Etiology
- •29.2.4 Clinical Features
- •29.2.5 Effects of Torsion of Testes
- •29.2.6 Investigations
- •29.2.7 Treatment
- •29.3 Torsion of the Testicular or Epididymal Appendage
- •29.3.1 Introduction
- •29.3.2 Embryology
- •29.3.3 Clinical Features
- •29.3.4 Investigations and Treatment
- •29.4.1 Introduction
- •29.4.2 Etiology
- •29.4.3 Clinical Features
- •29.4.4 Investigations and Treatment
- •29.5 Idiopathic Scrotal Edema
- •29.6 Testicular Trauma
- •29.7 Other Causes of Acute Scrotum
- •29.8 Splenogonadal Fusion
- •Further Reading
- •30.1 Introduction
- •30.2 Imperforate Hymen
- •30.3 Vaginal Atresia
- •30.5 Associated Anomalies
- •30.6 Embryology
- •30.7 Clinical Features
- •30.8 Investigations
- •30.9 Management
- •Further Reading
- •31: Disorders of Sexual Development
- •31.1 Introduction
- •31.2 Embryology
- •31.3 Sexual and Gonadal Differentiation
- •31.5 Evaluation of a Newborn with DSD
- •31.6 Diagnosis and Investigations
- •31.7 Management of Patients with DSD
- •31.8 Surgical Corrections of DSD
- •31.9 Congenital Adrenal Hyperplasia (CAH)
- •31.10 Androgen Insensitivity Syndrome (Testicular Feminization Syndrome)
- •31.13 Gonadal Dysgenesis
- •31.15 Ovotestis Disorders of Sexual Development
- •31.16 Other Rare Disorders of Sexual Development
- •Further Reading
- •Index
446 |
20 Utricular Cyst (Prostatic Utricular Cyst) |
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Figs. 20.5 and 20.6 Testicular ultrasound and Doppler ultrasound of a child with acute scrotum. Note the enlarged left epididymis which was found to be secondary to a utricular cyst
•This classification was based on urethrographic configuration.
–Grade 0: The utricle opening is located on the posterior urethra but the utricle does not extend over the verumontanum.
–Grade I: The utricular cyst is larger than grade 0 but the cyst does not reach the bladder neck.
–Grade II: The utricular cyst is more enlarged and its dome extends over the bladder neck.
–Grade III: In grades 0, I, and II, the prostatic utricle opens into the central area of the verumontanum, but when the opening is situated in the bulbous urethra just distal to the external sphincter, this is classified as grade III.
20.4Clinical Features
•Utricular cyst is a very rare congenital anomaly that arises from incomplete regression of the Mullerian ducts and commonly seen in males with perineal or penoscrotal hypospadias and in intersex disorders.
•Usually they are asymptomatic discovered incidentally.
•The presentation of utricular cysts is variable, and because many are asymptomatic, they escape detection.
•A prostatic utricle cyst is usually small in size and asymptomatic.
•A small prostatic utricle is occasionally seen as an incidental finding on routine VCUG as a tiny diverticulum of a few millimeters in length or on rare occasions measuring up to 1 cm.
•A large prostatic utricle is more often associated with male hypospadias. This is more commonly seen in those with proximal penile, penoscrotal and perineal hypospadias.
•This must be kept in mind as patients with a large prostatic utricle, direct catheterization of the bladder during surgical repair of hypospadias or during VCUG may be difficult secondary to preferential passage of the catheter into the utricle.
•The clinical presentation of utricular cyst is variable and include (Figs. 20.5 and 20.6):
–Recurrent UTI
–Recurrent epididymitis
–Hematuria
–Pyuria
–Urinary incontinence
–Urine retention
–Post void urinary drippling
–Constipation
–A pelvic mass
–Suprapubic or rectal pain
•Rarely it may enlarge and present as an abnormal lower abdominal or pelvic mass.
•When enlarged, it may be observed during pelvic or CT-scan as a fluid filled cavity between bladder and rectum.
20.5Investigations
•These patients should be investigated including abdominal and pelvic ultrasound and CT scan as well as a micturating cystourethrogam and or an ascending urethrogram.
•Voiding cystourethrogram (VCUG) and retrograde urethrography (RUG) can define the
20.6 Treatment |
447 |
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Figs. 20.7 and 20.8 A micturating cystourethrogram showing a large utricular cyst which is arising from the prostatic urethra. Note the large size of the cyst and its location
utricle size, which usually ranges from a few millimeters to more than 2 cm.
•VCUG is important to define the site of the cyst and its relation to the urethra as well as its size (Figs. 20.7 and 20.8).
•CT-scan will localize the site of the cyst, its shape and size as well as its relation to the urinary bladder and rectum (Figs. 20.9, 20.10, and 20.11).
•MRI can easily identify these cysts by virtue of their high signal on T2-weighted images but this investigation is reserved for cases that are difficult to diagnose by the more common and simpler investigations.
20.6Treatment
•Surgical excision is the treatment of choice for symptomatic utricular cysts.
Figs. 20.9 and 20.10 CT-scans showing a large utricular cyst
448 |
20 Utricular Cyst (Prostatic Utricular Cyst) |
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Fig. 20.11 CT-scan showing a large utricular cyst
•Surgical management of prostatic utricle cyst remains challenging, because of the rarity of this disorder and due to the close proximity of these lesions to the ejaculatory ducts, pelvic nerves, rectum, vas deferens and ureters.
•Surgical treatment should be reserved for symptomatic utricle cysts only.
•The definitive treatment of symptomatic utricular cyst is surgical excision but the approach remains controversial.
•Several surgical approaches have been described including:
–Endoscopic transurethral cyst catheterization and aspiration
–Cyst orifice dilatation
–Incision and deroofing
–Transperineal cyst aspiration and sclerotherapy
–Electrofulgaration
–Open excision (perineal, suprapubic extravesical, transperitoneal, parasacral, transvesical, transtrigonal, retropubic, posterior and anterior sagittal with rectal retraction, and transrectal posterior or anterior sagittal approach)
–Laparoscopic excision
–Robot-Assisted Laparoscopic Excision of Prostatic Utricle Cyst
•A suprapubic extravesical and extraperitoneal approach is a relatively easy and direct approach. Such an approach was however reported to have a high rate of incomplete excision. It is feared that total excision may compromise fertility by traumatically damaging or
accidentally excising both vas deference because of their close proximity or more commonly insertion in the utricular cyst. The importance of this need to be emphasizes and a preoperative thorough discussion with the parents in this regard is of paramount importance (Figs. 20.12, 20.13, and 20.14).
•Surgical complications include:
–Incomplete excision
–Impotence
–Excision of one or both seminal vesicles
–Excision of one or both vas
–Excision of portions of the prostate
–Rectal injury
20.7The Müllerian Duct Cyst
•The müllerian duct cyst is a remnant of the caudal ends of the fused müllerian duct, a structure that typically regresses in utero.
•These cysts are typically located in the midline, posterior to the bladder and above the prostate.
•Mullerian duct cysts generally do not communicate with the urethra
•Müllerian duct cysts do not communicate with the prostatic urethra, but are connected to the verumontanum by a thin stalk.
•Unlike utricular cysts, the müllerian duct cyst is not typically associated with other congenital abnormalities of the urinary tract and usually occurs as an isolated entity.
•Rarely, a müllerian duct cyst may be associated with renal agenesis.
•Rarely, calculi may occur within these cysts.
•The peak clinical incidence of müllerian duct cysts occurs in the age range of 20–40 years, as the cyst becomes larger and accumulates fluid.
•The clinical presentation is varied, including:
–Urinary frequency
–Urinary urgency
–Dysuria
–Urinary obstruction
–Hematuria
–Pelvic pain
•Digital rectal examination may reveal a midline cystic mass superior to the prostate gland.
Further Reading |
449 |
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Figs. 20.12, 20.13, and 20.14 A clinical intraoperative photograph showing a large utricular cyst being excised. Note its large size and its relation to the vas deference
•A müllerian duct cyst can be noted on a voiding cystourethrogram or an intravenous urogram, manifesting as an impression along the posterior wall of the bladder. A müllerian duct cyst does not communicate with the urethra and so will not be seen on a voiding cystourethrogram.
•Pelvic ultrasound and transrectal ultrasound will reveal a fluid-filled cyst projecting posterior and superiorly from the prostate, extending posterior to the urinary bladder.
•MRI is a valuable imaging modality for the evaluation of müllerian duct cysts.
•The müllerian duct cyst and utricle cyst both occur in the midline; however, the utricle cyst is typically smaller, confined to the base of the prostate, and communicates with the posterior urethra.
•Müllerian duct cysts are larger and extend above the base of the prostate.
Further Reading
1. Bhosle A, Patel S, Desai M. Asymptomatic large prostatic utricle. Indian J Urol. 2004;20:184–5.
2. Buchholz NP. Utricular cyst: a cause of recurrent urinary tract infection. Eur Urol. 1993;24:431–2.
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20 Utricular Cyst (Prostatic Utricular Cyst) |
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3. Desatuel MG, Stock J, Hanna MK. Mullerian duct remnants: surgical management and fertility issues. J Urol. 1999;162:1008–14.
4. Devine Jr CJ, Gonzales-Serva L, Stecker Jr JF, et al. Utricular configuration in hypospadias and intersex. J Urol. 1980;123:407–11.
5. Donkol RH, Monib S, Mogazy K. Mullerian duct cyst as a cause of acute infantile-onset epididymitis. Pediatr Radiol. 2006;36:1197–9.
6. Ikoma F, Shima H, Yabumoto H. Classification of enlarged prostatic utricle in patients with hypospadias. Br J Urol. 1985;57:334–7.
7. Johal NS, Kraklau D, Deniz K, Mushtaq I. An unusual case of a prenatally detected large mullerian duct remnant. Pediatr Surg Int. 2005;21:764–6.
8. Josso N, Cate RL, Picard J-Y, et al. Anti-mullerian hormone: the jost factor. Recent Prog Horm Res. 1993;48:1–59.
9. Kristic DZ, Smoljanic Z, Micovic Z, et al. Surgical treatment of the mullerian duct remnants. J Pediatr Surg. 2001;36:870–6.
10. Lane AH, Donahoe PK. New insights into mullerian inhibiting substance and its mechanism of action. J Endocrinol. 1998;158:1–6.
11. Okur H, Gough DC. Management of mullerian duct remnants. Urology. 2003;61:634–7.
12.Ramachandra M, Bendre PS, Redkar RS, Taide DV. Isolated prostatic utricle. J Indian Assoc Paediatr Surg. 2009;14:228–9.
13. Ritchey ML, Benson Jr RC, Kramer SA, et al. Management of Mullerian duct remnants in the male patient. J Urol. 1988;140:795–9.
14.Willetts IE, Roberts JP, Mackinnon AE. Laparoscopic excision of a prostatic utricle in a child. Pediatr Surg Int. 2003;19:557–8.