What is the initial approach to managing a penile cyst in an infant?

Management of Penile Cysts in Infants

The initial approach to managing a penile cyst in an infant should be observation, as many penile cysts resolve spontaneously without intervention. 1

Clinical Presentation and Diagnosis

• Penile cysts are uncommon congenital lesions that may develop when epithelial cells become entrapped during the fusion of labioscrotal folds 1
• Most penile cysts are present since birth but may only become detectable in adolescence or adulthood 2, 3
• The cysts are generally asymptomatic in infants and do not interfere with urinary function 2
• Differential diagnosis includes:
  • Epidermal inclusion cysts 4
  • Median raphe cysts 5
  • Mucoid cysts 2, 3
  • Other possibilities: dermoid cysts, pilonidal cysts, urethral diverticula 5

Initial Management Approach

• Conservative management with observation is the first-line approach for uncomplicated penile cysts in infants 1
• Physical examination should assess:
  • Size and location of the cyst
  • Relationship to other penile structures (urethra, corpora)
  • Whether the cyst interferes with urination 6
• Documentation should include:
  • Diameter of the lesion
  • Morphology (papillary, nodular, flat)
  • Number of lesions 6

Monitoring and Follow-up

• Regular follow-up examinations are recommended to monitor for:
  • Spontaneous resolution, which has been documented in case reports 1
  • Changes in size or character of the cyst
  • Development of complications such as infection or urinary obstruction 6
• Ultrasound imaging may be considered if there is concern about the depth or extent of the cyst 6

Indications for Intervention

• Surgical intervention is generally not indicated in asymptomatic infants 1, 2
• Consider intervention only if:
  • The cyst causes urinary obstruction
  • There is evidence of infection
  • The cyst significantly increases in size during follow-up 6
• When intervention is necessary, complete surgical excision with preservation of surrounding structures is the treatment of choice 2, 5

Long-term Considerations

• Most isolated penile cysts without associated anomalies have excellent prognosis 1
• Parents should be counseled that:
  • Many cysts resolve spontaneously during infancy 1
  • Even persistent cysts may remain asymptomatic throughout childhood 2, 3
  • Surgical intervention can be safely deferred until the child is older if the cyst remains asymptomatic 2

Pitfalls and Caveats

• Avoid unnecessary surgical procedures in infants as:
  • Spontaneous resolution may occur 1
  • Surgical trauma may lead to scarring and potential complications
  • Procedures on infant genitalia carry psychological considerations
• Ensure proper follow-up to monitor for rare but possible complications
• Consider referral to pediatric urology for complex or concerning cases 6