From the Research
Complete surgical excision is the recommended treatment for symptomatic median raphe cysts, with low recurrence rates, as supported by the most recent and highest quality study 1. A median raphe cyst is a benign congenital lesion that forms along the median raphe of the male genitalia, typically on the ventral surface of the penis. Management depends on symptoms and patient preference. Asymptomatic cysts generally require no treatment. For symptomatic cysts causing discomfort, pain, or cosmetic concerns,
- complete surgical excision is the recommended treatment with low recurrence rates,
- simple aspiration is not recommended as it typically leads to recurrence,
- marsupialization may be considered for larger cysts. Patients should be reassured that these cysts are benign and not infectious or sexually transmitted. Any surgical intervention should be performed by a urologist, and patients should be informed about potential complications including scarring, infection, and rarely, urethrocutaneous fistula. The cysts develop from embryological remnants of the urethral epithelium during development, which explains their location along the median raphe, as described in the literature 2, 3, 4, 5.
The most recent study 1 provides the strongest evidence for the management of median raphe cysts, and its findings support the recommendation for complete surgical excision. The study reports a case of a patient with a rare histological variant of median raphe cyst and provides a focused review on presentation, histopathology, and management. The patient underwent surgical excision of the cyst, and there was no evidence of recurrence in 2 years of follow-up. This study, along with others 2, 3, 4, 5, highlights the importance of proper diagnosis and treatment of median raphe cysts to prevent complications and improve patient outcomes.
In terms of histological findings, the most common type is the transitional cell type, followed by the mixed type (transitional and squamous) 2. However, the specific histological type does not affect the recommended treatment, which is complete surgical excision for symptomatic cysts. It is essential to note that any surgical intervention should be performed by a urologist, and patients should be informed about potential complications, as reported in the literature 1, 4.
Overall, the management of median raphe cysts depends on symptoms and patient preference, and complete surgical excision is the recommended treatment for symptomatic cysts, with low recurrence rates, as supported by the most recent and highest quality study 1.