Primary Retrovesical Hydatid Cyst causing Acute Urinary Retention in a Young Patient : A Rare Presentation

Retrovesical cysts are very rare. Definitive preoperative diagnosis is difficult in many cases. Hydatid cyst can present as a retrovescial cyst, which can cause a diagnostic dilemma. We present a case of primary retrovesical hydatid cyst mimicking a prostatic utricle cyst, presenting as acute urinary retention in a 29 year old young male patient. Definitive pre-operative diagnosis was difficult even with detailed imaging studies. Hence, exploratory laparotomy was done and diagnosis was suggested intra-operatively by the presence of slimy germinal layer and a daughter cyst and confirmed by histopathological examination. Hydatid disease is a zoonotic disease caused due to larvae of Ecchinococcus granulosus. Humans are the accidental intermediate hosts. Urogenital system is involved in 2.15% and in that, kidney is most commonly involved organ. As such, the retrovesical location is involved very rarely. Hence, retrovesical cysts are rare and hydatid cyst should be kept as differential diagnosis in mind while treating such cysts. S ur g er y S ec tio n Primary Retrovesical Hydatid Cyst causing Acute Urinary Retention in a Young Patient : A Rare Presentation LomeSh A. KApAdniS, ViKASh KumAr, Ajit S. SAwAnt, GAurAV V. KASAt, AShwin S. tAmhAnKAr CASE REPORT A 29-year-old male patient, butcher by occupation presented with acute urinary retention. He had history of irritative and obstructive lower urinary tract symptoms since last 6 months. He had no history of fever, hematuria, pyuria or any previous surgery in past. On examination, no lump was palpable per abdominally. On digital rectal examination, a smooth, spherical, firm mass was palpable, which could not be distinguished separately from prostate. Routine blood investigations were normal. Ultrasonography of abdomen revealed a well defined hypoechoic lesion in pelvis posterior to bladder compressing both ureters. On Transrectal ultrasonography a large well defined retrovesical cystic lesion in close proximity of prostate and prostatic urethra was noted [Table/Fig-1]. Contrast enhanced computed tomography (CECT) scan showed 11 x 10 x 11 cm thick walled peripherally enhancing cystic lesion with a thin septa along its postero-inferior wall, reaching upto sacrum and displacing bladder anteriorly and compressing rectum posteriorly [Table/Fig-2]. It was compressing right lower ureter causing proximal hydroureter and hydronephrosis. There was no similar cyst in other parts of abdomen. A diagnosis of prostatic utricle cyst was suspected on CT-scan. Patient developed right epididymo-orchitis which progressed into testicular abscess that had to be drained. Patient was