Spontaneous Pregnancy After Surgical Correction of a Prostatic Utricle Cyst and Recurrent Varicocele: A Case Report.

Abstract

Background: Prostatic utricle cysts are rare congenital anomalies arising from incomplete regression of the Müllerian ducts that may cause partial or complete ejaculatory duct obstruction, leading to hypospermia, abnormal semen parameters and even azoospermia in severe cases. Recurrent varicocele after previous surgical repair represents an additional challenge in the management of male infertility. Here, we report a case of spontaneous pregnancy achieved after combined surgical correction of a prostatic utricle cyst and recurrent left-sided varicocele in a couple not yet meeting the formal 12-month criteria for infertility, illustrating the diagnostic and therapeutic considerations relevant to this clinical scenario.

Case presentation: A 27-year-old man with a history of bilateral microsurgical varicocelectomy in 2018, persistent hypospermia (ejaculate volume 0.1-0.5 mL), reduced sperm motility (8%-24% progressive motility) and abnormal strict Kruger morphology (1%-3%) was evaluated together with his 35-year-old partner after 6 months of attempting natural conception. Scrotal Doppler ultrasonography confirmed recurrent left-sided varicocele, and pelvic magnetic resonance imaging revealed a prostatic utricle cyst measuring 1.6 × 1.0 cm. The female partner had no relevant abnormalities on complete gynaecological evaluation. The male partner underwent transurethral resection of the prostatic utricle cyst combined with subinguinal microsurgical redo varicocelectomy in a single surgical session without complications. Two months postoperatively, spontaneous clinical pregnancy was confirmed, and two semen analyses performed 4 months after surgery showed normalisation of all seminal parameters.

Conclusions: This case highlights the importance of comprehensive andrological evaluation, including imaging studies, in couples with a pre-existing, known male-factor abnormality, even when formal infertility criteria are not yet met. Prostatic utricle cysts should be considered in the differential diagnosis of obstructive male infertility, particularly in patients with unexplained hypospermia. In this case, combined correction of coexisting reproductive tract abnormalities was followed by normalisation of postoperative semen parameters and a favourable reproductive outcome; because semen analysis was performed only after conception had already occurred, a causal relationship with the pregnancy itself cannot be definitively established, but the findings support a positive physiological effect of surgery. Surgical reintervention for recurrent varicocele remains justified in selected patients with persistently abnormal semen parameters.