Brunn's Cyst Inducing Persistent Lower Urinary Tract Symptoms in a Young Man: A Case Report

Abstract

Background: Lower urinary tract symptoms (LUTS) are mostly caused by hyperplasia of the prostate in the elderly generation or are the consequence of a urethral stricture in young men. Proliferated Brunn's cell nests forming cysts at the bladder neck can likewise result in similar symptoms and can, therefore, often be overlooked. Case Presentation: The case describes a 46-year-old man presenting with the typical LUTS of urgency and pathologic residual urine volume of 350 mL. Sonographic and cystoscopic diagnostics showed a cystic lesion located at the bladder neck, acting as a ball valve mechanism. Transurethral deroofing and resection of the cyst resulted in an immediate resolution of LUTS and a symptom-free patient with no residual urine at follow-up. Conclusion: The presence of a Brunn's cyst is rare but should be kept in mind as a differential diagnosis of LUTS in young men.

Keywords: Brunn's cyst; bladder neck; lower urinary tract symptoms; obstruction; young men.

FIG. 1.

Transrectal ultrasonography images showing a 1.51 × 1.48 × 1.88 cm cystic lesion in the bladder neck region, above the prostate and separate from the ureterovesical junctions, with no connection to the ureteral orifices (A) surrounded by a 1.2 × 1.25 × 1.28 hyperechoic node complex with small cystic formations (B) showing low vascularization and hardening on elastography (C). The prostate volume was 35 mL (D).

FIG. 2.

Cystoscopic view of the cystic lesion and the consecutive bladder outlet obstruction (A–C). The cyst had no connection to the ureteral orifices. Endoscopic result after transurethral deroofing and resection of the Brunn's cyst (D–F).