A New Approach to Prostate Cysts: Evaluating Transurethral Cyst Wall Resection

A New Approach to Prostate Cysts: Evaluating Transurethral Cyst Wall Resection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A New Approach to Prostate Cysts: Evaluating Transurethral Cyst Wall Resection Farshad Banouei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7151848/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Prostate cysts are a common reason for patients to seek care in urology clinics worldwide. Various treatment methods have been proposed, each with its own set of advantages and disadvantages. This study aims to investigate one such method: transurethral cyst wall resection. Materials and Methods: This case series was conducted in Iran between 2023 and 2024, involving 27 patients aged 34 to 81 years with prostate cysts who experienced bothersome symptoms of irritation and obstruction. These patients were unwilling to undergo conventional prostate surgery and sought drainage of the prostate cyst with minimal complications. Prior to surgery, all patients underwent comprehensive examinations. The patients then underwent transurethral resection of the cyst wall, after which a Foley catheter was inserted for 48 hours. The catheter was subsequently removed, and the patients were discharged. Follow-up evaluations were conducted one week after cyst resection, as well as at 6 and 12 months post-surgery. Results: The study found no significant complications during the follow-up examinations at one week, 6 months, and 12 months after surgery. Patients' Qmax levels increased significantly, while their IPSS scores decreased. No cases of retrograde ejaculation were observed. Cyst recurrence was noted in only one patient (3%). Additionally, signs of urethral stricture were observed in one patient during the 12-month follow-up. Discussion: Resection of the prostate cyst wall that has protruded into the prostatic urethra and bladder is a quick, accessible, and cost-effective method. It is associated with minimal complications following surgery and could serve as a viable alternative to more invasive and expensive treatment options currently available. Clinical trial number: Not applicable Prostate cyst transurethral resection urethral stricture Figures Figure 1 Figure 2 Introduction Today, difficulty urinating is one of the most common reasons for patients to visit emergency rooms and urology clinics around the world. This issue has various causes that differ by age, ranging from urinary obstruction with transient causes to more complex neurogenic problems.( 1 , 2 ). One of the less common causes of lower urinary tract symptoms (LUTS) is the development of prostate cysts. Typically, because these cysts form slowly, most patients experience few symptoms, which are usually storage symptoms but can sometimes be voiding symptoms. Furthermore, statistics from the World Health Organization indicate that these cysts are found in 4 to 17 percent of infertile couples( 3 , 4 ). The vast majority of prostate cysts are benign and do not require treatment; they are often referred to as "do-not-touch" lesions. Although most cases are asymptomatic, they can be associated with symptoms and conditions such as urinary tract infections, hematospermia, infertility, and genitourinary malformations, including ipsilateral renal agenesis, hypospadias, and cryptorchidism( 5 ). Currently, various treatment methods are being researched and developed for these cysts, including open surgery, laparoscopic surgery, and transrectal procedures. Each of these approaches has its own specific advantages and disadvantages. ( 6 ). Research on prostate cysts in dogs has employed techniques such as percutaneous drainage, sclerotherapy, open surgery, and peritonealization of the cyst. One of the most recent advancements is the use of platelet-rich plasma for treating prostate cysts in dogs, which has shown promising results.( 7 ). One method that can be recommended for treating prostate cysts is resection through the urethra. This approach is considered straightforward and is readily available in most urology centers. In this study, we aim to investigate this simple technique, which has a low complication rate, specifically focusing on the process of draining the cyst through unroofing. Unroofing involves creating an opening in the cyst wall to allow its contents to be drained, thereby reducing pressure and alleviating symptoms. This minimally invasive procedure not only aims to provide immediate relief but also focuses on preserving surrounding tissues, making it a favorable option for many patients. We will also examine the long-term outcomes of this method, including the recurrence rate of cysts, improvement in urinary symptoms, and overall patient satisfaction. By assessing these factors, we hope to determine the efficacy and safety of urethral resection as a treatment option for prostate cysts. Materials and Methods The present study is a case series investigation conducted between 2023 and 2024 at Valiasr Hospital in Tuyserkan, Iran. We examined 27 patients with prostate cysts, whose ages ranged from 34 to 81 years. Patients presenting to the urology clinic with obstructive or irritative symptoms underwent an initial evaluation, which included a digital rectal exam (DRE). Following this, prostate-specific antigen (PSA) tests were ordered to rule out prostate malignancies. Subsequently, abdominal and transrectal ultrasounds were performed. Abdominopelvic CT scans were performed to accurately assess the relationship of the cyst to adjacent organs. In cases where there was suspicion regarding the cyst's relationship to adjacent viscera on imaging, patients were excluded from the study. Urine cultures and analyses were also conducted, and appropriate antibiotic treatment was initiated if urinary tract infections were detected. The diameters of the cysts in these patients ranged from 3.4 to 12.3 cm. Figure1. In order to further investigate and quantify the severity of symptoms before and after surgery, patients also underwent uroflowmetry, and IPSS levels were measured before and after surgery. In this study, only patients who had bothersome symptoms, did not respond to drug treatment, and were not willing to undergo prostate surgery were included in the study. After confirming that the cysts were symptomatic, patients were taken to the operating room, where spinal anesthesia was administered. Cystoscopy was then performed to identify the appropriate site for cyst roof resection. The cyst roof was unroofed through the urethra, and the cyst contents were completely drained. A 20-French three-way Foley catheter was inserted for two days. Figure2. Patients were discharged 48 hours post-surgery, after receiving antibiotics, and the Foley catheter was removed. One week following the surgery, patients were re-evaluated with a digital rectal examination, and transabdominal and transrectal ultrasounds were repeated at 6 and 12 months post-operation. To check for stenosis and how to repair the cyst resection site At the 12-month mark, cystoscopy was performed again under general anesthesia. Results In this study, a total of 27 patients were examined and treated for prostate cysts. The ages of these patients ranged from 34 to 81 years, with an average age of 51.4 years. Upon initial examination, the size of the cysts varied from 3.4 to 12.3 cm, with an average size of 7.2 cm. Before and after surgery, uroflowmetry and IPSS measurements were performed in these patients. The average Qmax before surgery in these patients was 9.3 ml/sec before surgery and increased to 24.4 ml/sec after surgery, which was statistically significant and very impressive (p = 0.003). The average IPSS score of the patients also decreased from 28.4 before surgery to 11.3 after surgery, which was also statistically significant (p = 0.02). During the first week following treatment, only three patients (11%) reported dysuria and mild hematuria. These symptoms were effectively managed and resolved with a course of anticholinergics and finasteride. Follow-up transrectal and transabdominal ultrasounds conducted at the end of the first week showed no residual cysts in any of the patients. At the six-month follow-up visit, complete resolution of both the cysts and any associated symptoms was observed in 26 patients. However, one patient (3%) displayed signs of cyst recurrence on transrectal ultrasound. Since this patient did not exhibit any clinical symptoms, it was decided to continue monitoring without immediate intervention. During the third follow-up visit, no signs of cyst recurrence were noted among the patients. The individual who had shown signs of recurrence at the six-month mark continued to be monitored, as there was no increase in the size of the cyst. Overall, the post-operative evaluations revealed no significant complications for the majority of patients. However, one patient experienced mild stenosis of the bulbomembranous urethra, which was successfully treated with an internal urethrotomy. This intervention resolved the issue completely. Discussion Depending on the location of the prostate cysts and troubling symptoms they can cause, selecting an appropriate treatment method has become essential. Advances in endourological surgical techniques and the use of miniature instruments have greatly facilitated this process. Transurethral resection of prostate cysts is one of the least invasive, most accessible, cost-effective, and straightforward approaches available. This study examined the outcomes associated with this method.، The significant reduction in the patients' IPSS score and increase in urine flow rate in this study showed that the use of this technique in patients with large cysts in the prostatic urethra who have not responded to drug treatment and are unwilling to undergo conventional prostate surgery can open new ways for these patients. The findings indicate that this technique can effectively reduce the recurrence of prostate cysts in patients. However, broader application of this method across various types of prostate cysts necessitates further research involving larger sample sizes and extended follow-up periods to better assess the potential for long-term recurrence. The disadvantages of this method include that it cannot be used for cysts located deep in the prostate tissue, although this method is only recommended for superficial cysts in patients who do not wish to undergo more aggressive prostate surgeries. Conclusion Overall, resection of the cyst wall through the urethra is a quick and widely available option in many urology centers globally. It has the potential to serve as a suitable alternative to more invasive methods that carry a higher risk of complications in the future. Abbreviations • PSA Prostate Specific Antigen • DRE Digital Rectal Exam • TUR Transurethral Resection • LUTS Lower Urinary Tract Symptoms • IPSS International Prostate Symptom Score • CT Computed Tomography Declarations Ethics Approval and Consent to Participate: This study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Ethics Committee of Hamadan University of Medical Sciences, Hamadan, Iran (Ethics approval reference number: IR.UMSHA.REC.1400.284). All participants provided written informed consent prior to enrollment in the study. Consent for Publication: Written informed consent for publication of clinical details and any identifying images was obtained from all participants. Patients consented to the use of their clinical data for research and publication purposes while maintaining anonymity. Data Availability Statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request, subject to institutional data sharing policies and participant privacy protection. Competing Interests: The authors declare no competing interests related to this study. Funding: This research was funded entirely by the corresponding author, Farshad Banouei. No external funding sources were utilized. Author Contributions: FB conceived the study design, performed all surgical procedures, collected and analyzed patient data, and drafted the manuscript. FB reviewed and approved the final manuscript for submission. Acknowledgements: The authors thank the nursing staff at Valiasr Hospital for their assistance in patient care and data collection. CARE Statement Compliance: This case series adheres to the CARE (CAse REport) guidelines for reporting clinical case studies. A completed CARE checklist is provided as supplementary material. References Peters CA. Urinary tract obstruction in children. The Journal of urology. 1995;154(5):1874-84. Gulmi FA, Felsen D. Pathophysiology of urinary tract obstruction. Smith's textbook of endourology. 2012:95-119. Lotti F, Corona G, Cocci A, Cipriani S, Baldi E, Degl’Innocenti S, et al. The prevalence of midline prostatic cysts and the relationship between cyst size and semen parameters among infertile and fertile men. Human Reproduction. 2018;33(11):2023-34. Kim E, Onel E, Honig S, Lipshultz L. The prevalence of cystic abnormalities of the prostate involving the ejaculatory ducts as detected by transrectal ultrasound. International urology and nephrology. 1997;29:647-52. Pacheco EO, Houat AP, Velloni FG, Blasbalg R, Yamauchi FI, Bittencourt LK, et al. Male pelvic cysts: a didactic diagnostic approach. RadioGraphics. 2021;41(6):E179-E80. Cunto M, Mariani E, Anicito Guido E, Ballotta G, Zambelli D. Clinical approach to prostatic diseases in the dog. Reproduction in Domestic Animals. 2019;54(6):815-22. Bigliardi E, Cantoni AM, De Cesaris V, Denti L, Conti V, Bertocchi M, et al. Use of platelet-rich plasma for the treatment of prostatic cysts in dogs. Canadian Journal of Veterinary Research. 2018;82(4):264-70. Additional Declarations No competing interests reported. Supplementary Files CAREchecklistEnglish2013.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7151848","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509660492,"identity":"26e78d75-ffb2-4895-b64a-ba4ae8fa14dc","order_by":0,"name":"Farshad Banouei","email":"data:image/png;base64,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","orcid":"","institution":"Hamedan university of Medical sciences","correspondingAuthor":true,"prefix":"","firstName":"Farshad","middleName":"","lastName":"Banouei","suffix":""}],"badges":[],"createdAt":"2025-07-17 19:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7151848/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7151848/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90879768,"identity":"0ec55df8-4aa1-4fc3-8317-1cac83cba37d","added_by":"auto","created_at":"2025-09-09 09:37:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":226533,"visible":true,"origin":"","legend":"\u003cp\u003eLarge prostate cyst demonstrated on imaging\u003c/p\u003e\n\u003cp\u003eRepresentative image showing a large prostate cyst measuring 12.3 cm in diameter. The cyst demonstrates clear fluid content and well-defined margins on cross-sectional imaging.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7151848/v1/589c516c1e771ad0b12ddcfa.png"},{"id":90881518,"identity":"fe11306b-d365-449d-ada0-749cff25ff6c","added_by":"auto","created_at":"2025-09-09 09:45:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":257420,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative view during cyst drainage\u003c/p\u003e\n\u003cp\u003eCystoscopic image showing purulent material being evacuated immediately after initial resection of the cyst wall, demonstrating successful communication between the cyst cavity and prostatic urethra.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7151848/v1/298c0249b3d31433c5ed0b14.png"},{"id":92664878,"identity":"a6d05c0e-b7a0-4f27-9efc-05dc0a030159","added_by":"auto","created_at":"2025-10-02 16:01:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":940235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151848/v1/735da9f0-8944-4fbf-844a-13518849f31a.pdf"},{"id":90879771,"identity":"b3b309f7-4f23-4b69-8b93-36f7c5cb139e","added_by":"auto","created_at":"2025-09-09 09:37:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":718365,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklistEnglish2013.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151848/v1/5c4ea664646ffeb0f1970f00.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A New Approach to Prostate Cysts: Evaluating Transurethral Cyst Wall Resection","fulltext":[{"header":"Introduction","content":"\u003cp\u003eToday, difficulty urinating is one of the most common reasons for patients to visit emergency rooms and urology clinics around the world. This issue has various causes that differ by age, ranging from urinary obstruction with transient causes to more complex neurogenic problems.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne of the less common causes of lower urinary tract symptoms (LUTS) is the development of prostate cysts. Typically, because these cysts form slowly, most patients experience few symptoms, which are usually storage symptoms but can sometimes be voiding symptoms. Furthermore, statistics from the World Health Organization indicate that these cysts are found in 4 to 17 percent of infertile couples(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe vast majority of prostate cysts are benign and do not require treatment; they are often referred to as \"do-not-touch\" lesions. Although most cases are asymptomatic, they can be associated with symptoms and conditions such as urinary tract infections, hematospermia, infertility, and genitourinary malformations, including ipsilateral renal agenesis, hypospadias, and cryptorchidism(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCurrently, various treatment methods are being researched and developed for these cysts, including open surgery, laparoscopic surgery, and transrectal procedures. Each of these approaches has its own specific advantages and disadvantages. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch on prostate cysts in dogs has employed techniques such as percutaneous drainage, sclerotherapy, open surgery, and peritonealization of the cyst. One of the most recent advancements is the use of platelet-rich plasma for treating prostate cysts in dogs, which has shown promising results.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne method that can be recommended for treating prostate cysts is resection through the urethra. This approach is considered straightforward and is readily available in most urology centers. In this study, we aim to investigate this simple technique, which has a low complication rate, specifically focusing on the process of draining the cyst through unroofing. Unroofing involves creating an opening in the cyst wall to allow its contents to be drained, thereby reducing pressure and alleviating symptoms. This minimally invasive procedure not only aims to provide immediate relief but also focuses on preserving surrounding tissues, making it a favorable option for many patients. We will also examine the long-term outcomes of this method, including the recurrence rate of cysts, improvement in urinary symptoms, and overall patient satisfaction. By assessing these factors, we hope to determine the efficacy and safety of urethral resection as a treatment option for prostate cysts.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe present study is a case series investigation conducted between 2023 and 2024 at Valiasr Hospital in Tuyserkan, Iran. We examined 27 patients with prostate cysts, whose ages ranged from 34 to 81 years.\u003c/p\u003e\n\u003cp\u003ePatients presenting to the urology clinic with obstructive or irritative symptoms underwent an initial evaluation, which included a digital rectal exam (DRE). Following this, prostate-specific antigen (PSA) tests were ordered to rule out prostate malignancies. Subsequently, abdominal and transrectal ultrasounds were performed. Abdominopelvic CT scans were performed to accurately assess the relationship of the cyst to adjacent organs. In cases where there was suspicion regarding the cyst\u0026apos;s relationship to adjacent viscera on imaging, patients were excluded from the study. Urine cultures and analyses were also conducted, and appropriate antibiotic treatment was initiated if urinary tract infections were detected.\u003c/p\u003e\n\u003cp\u003eThe diameters of the cysts in these patients ranged from 3.4 to 12.3 cm. Figure1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn order to further investigate and quantify the severity of symptoms before and after surgery, patients also underwent uroflowmetry, and IPSS levels were measured before and after surgery. In this study, only patients who had bothersome symptoms, did not respond to drug treatment, and were not willing to undergo prostate surgery were included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter confirming that the cysts were symptomatic, patients were taken to the operating room, where spinal anesthesia was administered. Cystoscopy was then performed to identify the appropriate site for cyst roof resection. The cyst roof was unroofed through the urethra, and the cyst contents were completely drained. A 20-French three-way Foley catheter was inserted for two days. Figure2.\u003c/p\u003e\n\u003cp\u003ePatients were discharged 48 hours post-surgery, after receiving antibiotics, and the Foley catheter was removed. One week following the surgery, patients were re-evaluated with a digital rectal examination, and transabdominal and transrectal ultrasounds were repeated at 6 and 12 months post-operation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo check for stenosis and how to repair the cyst resection site At the 12-month mark, cystoscopy was performed again under general anesthesia.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, a total of 27 patients were examined and treated for prostate cysts. The ages of these patients ranged from 34 to 81 years, with an average age of 51.4 years. Upon initial examination, the size of the cysts varied from 3.4 to 12.3 cm, with an average size of 7.2 cm.\u003c/p\u003e\u003cp\u003eBefore and after surgery, uroflowmetry and IPSS measurements were performed in these patients. The average Qmax before surgery in these patients was 9.3 ml/sec before surgery and increased to 24.4 ml/sec after surgery, which was statistically significant and very impressive (p\u0026thinsp;=\u0026thinsp;0.003). The average IPSS score of the patients also decreased from 28.4 before surgery to 11.3 after surgery, which was also statistically significant (p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e\u003cp\u003eDuring the first week following treatment, only three patients (11%) reported dysuria and mild hematuria. These symptoms were effectively managed and resolved with a course of anticholinergics and finasteride. Follow-up transrectal and transabdominal ultrasounds conducted at the end of the first week showed no residual cysts in any of the patients.\u003c/p\u003e\u003cp\u003eAt the six-month follow-up visit, complete resolution of both the cysts and any associated symptoms was observed in 26 patients. However, one patient (3%) displayed signs of cyst recurrence on transrectal ultrasound. Since this patient did not exhibit any clinical symptoms, it was decided to continue monitoring without immediate intervention.\u003c/p\u003e\u003cp\u003eDuring the third follow-up visit, no signs of cyst recurrence were noted among the patients. The individual who had shown signs of recurrence at the six-month mark continued to be monitored, as there was no increase in the size of the cyst.\u003c/p\u003e\u003cp\u003eOverall, the post-operative evaluations revealed no significant complications for the majority of patients. However, one patient experienced mild stenosis of the bulbomembranous urethra, which was successfully treated with an internal urethrotomy. This intervention resolved the issue completely.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDepending on the location of the prostate cysts and troubling symptoms they can cause, selecting an appropriate treatment method has become essential. Advances in endourological surgical techniques and the use of miniature instruments have greatly facilitated this process.\u003c/p\u003e\u003cp\u003eTransurethral resection of prostate cysts is one of the least invasive, most accessible, cost-effective, and straightforward approaches available. This study examined the outcomes associated with this method.،\u003c/p\u003e\u003cp\u003eThe significant reduction in the patients' IPSS score and increase in urine flow rate in this study showed that the use of this technique in patients with large cysts in the prostatic urethra who have not responded to drug treatment and are unwilling to undergo conventional prostate surgery can open new ways for these patients.\u003c/p\u003e\u003cp\u003eThe findings indicate that this technique can effectively reduce the recurrence of prostate cysts in patients. However, broader application of this method across various types of prostate cysts necessitates further research involving larger sample sizes and extended follow-up periods to better assess the potential for long-term recurrence.\u003c/p\u003e\u003cp\u003eThe disadvantages of this method include that it cannot be used for cysts located deep in the prostate tissue, although this method is only recommended for superficial cysts in patients who do not wish to undergo more aggressive prostate surgeries.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, resection of the cyst wall through the urethra is a quick and widely available option in many urology centers globally. It has the potential to serve as a suitable alternative to more invasive methods that carry a higher risk of complications in the future.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; PSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProstate Specific Antigen\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; DRE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDigital Rectal Exam\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; TUR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTransurethral Resection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; LUTS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLower Urinary Tract Symptoms\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; IPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Prostate Symptom Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; CT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate:\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Ethics Committee of Hamadan University of Medical Sciences, Hamadan, Iran (Ethics approval reference number: IR.UMSHA.REC.1400.284). All participants provided written informed consent prior to enrollment in the study.\u003c/p\u003e\n\u003cp\u003eConsent for Publication:\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of clinical details and any identifying images was obtained from all participants. Patients consented to the use of their clinical data for research and publication purposes while maintaining anonymity.\u003c/p\u003e\n\u003cp\u003eData Availability Statement:\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request, subject to institutional data sharing policies and participant privacy protection.\u003c/p\u003e\n\u003cp\u003eCompeting Interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests related to this study.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThis research was funded entirely by the corresponding author, Farshad Banouei. No external funding sources were utilized.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions:\u003c/p\u003e\n\u003cp\u003eFB conceived the study design, performed all surgical procedures, collected and analyzed patient data, and drafted the manuscript. FB reviewed and approved the final manuscript for submission.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eThe authors thank the nursing staff at Valiasr Hospital for their assistance in patient care and data collection.\u003c/p\u003e\n\u003cp\u003eCARE Statement Compliance:\u003c/p\u003e\n\u003cp\u003eThis case series adheres to the CARE (CAse REport) guidelines for reporting clinical case studies. A completed CARE checklist is provided as supplementary material.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePeters CA. Urinary tract obstruction in children. The Journal of urology. 1995;154(5):1874-84.\u003c/li\u003e\n\u003cli\u003eGulmi FA, Felsen D. Pathophysiology of urinary tract obstruction. Smith\u0026apos;s textbook of endourology. 2012:95-119.\u003c/li\u003e\n\u003cli\u003eLotti F, Corona G, Cocci A, Cipriani S, Baldi E, Degl\u0026rsquo;Innocenti S, et al. The prevalence of midline prostatic cysts and the relationship between cyst size and semen parameters among infertile and fertile men. Human Reproduction. 2018;33(11):2023-34.\u003c/li\u003e\n\u003cli\u003eKim E, Onel E, Honig S, Lipshultz L. The prevalence of cystic abnormalities of the prostate involving the ejaculatory ducts as detected by transrectal ultrasound. International urology and nephrology. 1997;29:647-52.\u003c/li\u003e\n\u003cli\u003ePacheco EO, Houat AP, Velloni FG, Blasbalg R, Yamauchi FI, Bittencourt LK, et al. Male pelvic cysts: a didactic diagnostic approach. RadioGraphics. 2021;41(6):E179-E80.\u003c/li\u003e\n\u003cli\u003eCunto M, Mariani E, Anicito Guido E, Ballotta G, Zambelli D. Clinical approach to prostatic diseases in the dog. Reproduction in Domestic Animals. 2019;54(6):815-22.\u003c/li\u003e\n\u003cli\u003eBigliardi E, Cantoni AM, De Cesaris V, Denti L, Conti V, Bertocchi M, et al. Use of platelet-rich plasma for the treatment of prostatic cysts in dogs. Canadian Journal of Veterinary Research. 2018;82(4):264-70.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prostate cyst, transurethral resection, urethral stricture","lastPublishedDoi":"10.21203/rs.3.rs-7151848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7151848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003eProstate cysts are a common reason for patients to seek care in urology clinics worldwide. Various treatment methods have been proposed, each with its own set of advantages and disadvantages. This study aims to investigate one such method: transurethral cyst wall resection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e This case series was conducted in Iran between 2023 and 2024, involving 27 patients aged 34 to 81 years with prostate cysts who experienced bothersome symptoms of irritation and obstruction. These patients were unwilling to undergo conventional prostate surgery and sought drainage of the prostate cyst with minimal complications. Prior to surgery, all patients underwent comprehensive examinations. The patients then underwent transurethral resection of the cyst wall, after which a Foley catheter was inserted for 48 hours. The catheter was subsequently removed, and the patients were discharged. Follow-up evaluations were conducted one week after cyst resection, as well as at 6 and 12 months post-surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study found no significant complications during the follow-up examinations at one week, 6 months, and 12 months after surgery. Patients' Qmax levels increased significantly, while their IPSS scores decreased. No cases of retrograde ejaculation were observed. Cyst recurrence was noted in only one patient (3%). Additionally, signs of urethral stricture were observed in one patient during the 12-month follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003eResection of the prostate cyst wall that has protruded into the prostatic urethra and bladder is a quick, accessible, and cost-effective method. It is associated with minimal complications following surgery and could serve as a viable alternative to more invasive and expensive treatment options currently available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"A New Approach to Prostate Cysts: Evaluating Transurethral Cyst Wall Resection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 09:36:57","doi":"10.21203/rs.3.rs-7151848/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dc9c95bd-59dc-457a-a69b-563728418fbf","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-02T15:53:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 09:36:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7151848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7151848","identity":"rs-7151848","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}