CYSTOSCOPY AND MUCOSECTOMY: ESSENTIALS IN THE MANAGEMENT OF PERSISTENT MULLERIAN DUCT SYNDROME WITH TRANSVERSE TESTICULAR ECTOPIA

Abstract

OBJECTIVES: The concurrence of Persistent Mullerian Duct Syndrome and transverse testicular ectopia is rare. The risk of damage to the vas deferens and the deferential blood supply hinders some surgeons from complete excision of potentially malignant Mullerian duct remnants. METHODS: We present a unique surgical technique of Persistent Mullerian Duct Syndrome in a patient with right inguinal hernia accompanying transverse testicular ectopia. RESULTS: During exploration, both testes were detected in the right inguinal canal. When the hernia sac was opened, a primitive uterus and fallopian tubes without fimbria were identified confirming Persistent Mullerian Duct Syndrome. A 4 Fr catheter was placed into the os of the Mullerian duct remnants via the verumontanumorifice, and then a urethral catheter was placed. The full-thickness excision of proximal Mullerian duct remnant swere performed. The distal part of Mullerian duct remnants was layed open and only mucosa was excised for preserving vas deferens. Resection was completed just above its junction with the urethra with the aid of 4Fr catheter marked at centimeter intervals and the cuffwas oversewn. High ligation for right inguinal hernia and bilateral orchidopexy were performed. CONCLUSIONS: Removal of Mullerian duct remnantsis advised in order to reduce the jeopardy of malignancy, urinary tract infections, stones and hematuria. On the other hand, excision down to urethra which can compromise the integrity and vascularity of the vas deferens is diffucult, even in experienced surgical hands. Complete excision of these structures by mucosectomy of the distal part of remnant which lay closed to vas deferens is a safe and effective method. Cystoscopy assistance and placement of a catheter into MDRs were essential for the complete excision of this mucosa. To the best of our knowledge, cystoscopy assisted mucosectomy in Persistent Mullerian Duct Syndrome has not been reported previously.