Median raphe cyst of the penis is an uncommon benign congenital cyst that can be seen anywhere between the tip of the penis and the anus. It can develop at any site along the ventral midline between the urethral meatus and the anus, but most commonly seen near the glans and the shaft of penis.
It is thought that Median raphe cyst is the result of embryologic developmental defects of the male urethra that can either be abnormal closing of the median raphe or abnormal separation of the urethral epithelium during development.
Most of the cases of Median raphe cyst may go unnoticed during childhood and may progress or enlarge slowly to become prominent and symptomatic during adulthood. Cyst may sometimes suddenly appear after infection (staphylococcal or gonococcal infections) or mild trauma to the penis (in few cases after vigorous sex).
Even when present they are usually not symptomatic because of their location and small size. When large or when present near the tip of penis they can be symptomatic causing pain, discomfort and trauma that can sometime lead to difficulty in sexual intercourse.
Other condition that can sometime resemble median raphe cysts are glomus tumour, dermoid cyst, pilonidal cyst, epidermal inclusion cyst, urethral diverticulum, and steatocystoma.
Although these cysts on penis are harmless every man wants it removed for cosmetic and personal concern (difficulty in having sex). The treatment of choice is local excision. If the individual doesn’t wants a surgery, aspiration of the cyst can be done but the recurrence rate is higher. Beside few rare surgical complications like urethrocutaneous fistula, most of the cases have no complications at all. So, the treatment of choice for median raphe cyst is complete local excision.
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