Case Study: Two Comparative Rare Cases of Parameatal Urethral Cysts in Children: Is Surgical Excision Necessary?

Abstract

Parameatal urethral cysts are relatively common in children and often asymptomatic. However, approximately 20% of cases present with urinary disturbances or other complications. Due to their rarity, no standardized treatment guidelines currently exist. This case study aims to explore the natural history of parameatal urethral cysts in children and to propose treatment recommendations. Data were collected from the medical records of two pediatric patients diagnosed with parameatal urethral cysts who received treatment at Samutprakan Hospital between October 1, 2016, and May 31, 2024. A comparative analysis was conducted using international case reports as references.

International case studies indicate that in asymptomatic patients with cysts smaller than 5 millimeters, 6 - 25% resolve spontaneously within an average of 5.5 to 24 months, suggesting that a follow-up period of at least 24 months is advisable. If the cyst does not resolve during this period, cyst excision is recommended. For symptomatic patients with cysts 5 millimeters or larger, cyst excision is generally indicated. In this study, the first patient, who presented with urinary flow disturbances and a 1-centimeter cyst, experienced spontaneous resolution after 18 months of follow-up, contrary to international trends. The second patient, asymptomatic with a 1-centimeter cyst, did not experience spontaneous resolution after a 5-year follow-up, necessitating cyst excision. Post-surgical follow-up at two months showed no recurrence or urethral stricture.

These findings suggest that in asymptomatic or mildly symptomatic patients, even with cysts larger than 5 millimeters, observation may be a reasonable initial approach. Surgical excision should be considered if the cyst does not resolve after 24 months.