Male median raphe cysts: serial retrospective analysis and histopathological classification
© Shao et al.; licensee BioMed Central Ltd. 2012
Received: 17 June 2012
Accepted: 2 September 2012
Published: 14 September 2012
To review the clinical and pathological characteristics of median raphe cysts and to classify the lesions according to pathogenesis and histopathological findings.
The medical records of patients who were diagnosed with median raphe cysts between 2001 and 2010 were reviewed to document the clinical presentation and pathological findings of the cysts.
Most patients were asymptomatic; however, 9 patients had inflammatory or infectious cysts that were tender or painful. Four patients who had cysts on the parameatus and distal prepuce had difficulty voiding. Hematuria and hematospermia were noted in 2 cases. Thirty-one cysts were lined with an urothelium-like epithelium, and a squamous epithelium lining was found in 3 cases. In 2 cases, a well-formed mucinous glandular structure was observed. The other 20 cysts consisted of mixed epithelia. After excision of the cysts under local or general anesthesia, an urethral fistula developed as a complication in only 1 case.
Median raphe cysts are benign lesions formed due to tissue trapping during the development of urethral folds. The cysts can be defined into 4 types based on pathological findings: urethral, epidermoid, glandular, and mixed. The associated symptoms and signs should be taken into consideration when determining the treatment for the cysts.
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We retrospectively reviewed the medical records, including the pathological diagnoses, of all patients with cysts on the median raphe (from the meatus to the perineum) diagnosed between 2001 and 2010 in our institution. Patients with epidermal inclusion cysts, skin tags, or cysts located anywhere other than the median raphe were excluded. Medical charts were reviewed to document the clinical presentation, characteristics of the cysts (including the occurrence site, cyst size, and histopathological findings), and patients outcomes.
This study was approved by our institutional review board in Chang Gung Memorial Hospital.
Results and discussion
General data and characteristics of patient
Average age (range)
26.7 y/o (1 y/o – 66 y/o)
No. Age distribution (%)
0 ~ 10 y/o
11 ~ 20 y/o
21 ~ 30 y/o
31 ~ 40 y/o
41 ~ 50 y/o
51 ~ 60 y/o
61 ~ 70 y/o
No. symptom/total No. (%)
Pain / inflammation
No. location/total (%)
Average diameter of the cyst in cetimeter (range)
0.80 (0.2 ~ 3.0)
0.95 (0.6 ~ 11.3)
0.79 (0.2 ~ 1.5)
2.0 (1.9 ~ 2.1)
0.92 (0.5 ~ 1.2)
No. pathological type (%)
Urethral type epithelium
Epidermoid type epithelium
Glandular type epithelium
Mixed type epithelium
No. complication / recurrence (%)
No surgical complications were encountered, except in 1 case where urethrocutaneous fistula formation occurred owing to long-term chronic inflammation adjacent to the urethra. Among the 55 patients, 1 underwent cyst aspiration, and recurrence was noted several months later. No signs of malignancy were found in any of the patients, either clinically or pathologically.
The histopathological features of median raphe cysts are varied and can be classified into 4 types of cell manifestations. The diversification of the epithelium may be due to a congenital anomaly of the genitalia, with remnants of embryogenesis or acquired metaplasia of the genitalia. However, no malignant potentiality was observed during long-term follow-up in our study. The associated symptoms and signs should be considered in the treatment of these cysts.
IHS carried out the preparation of the manuscript draft and participated in the analysis and interpretation of the data. TDC reviewed the pathological results and analyzed and interpreted the data. STS participated in the data collection. HWC participated in the revision and editing of the manuscript. IHS and TDC contributed equally to this study. All the authors read and approved the final manuscript.
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