Introduction:
Prepubic sinus (PPS) is a rare congenital anomaly characterized by a midline tract, typically located dorsally to the urethra and opening near the base of the penis. Fewer than 50 cases have been reported in the literature, and its etiology remains debated. Some authors consider PPS a variant of urethral duplication, supported by histological findings of transitional epithelium in many cases.
Case Reports:
We present two male patients, aged 4 and 15 years, referred for a small pit-like opening at the base of the penis, caudal to the pubic symphysis. Both had no history of urinary symptoms, infection, nor pain, and only the second mentioned an intermitent low-volume serous discharge. In the older patient, magnetic resonance imaging confirmed a midline blind-ending tract with no communication to the urinary tract.
Surgery consisted of complete excision of the, after fistulography with methylene blue was performed to delineate the tract at the beginning of the procedure. Intraoperative findings confirmed a blind-ending sinus with no communication to the urethra nor bladder.
Both patients recovered uneventfully and were discharged on the first postoperative day. No recurrence or complications were observed.
Conclusion:
Prepubic sinus is an extremely rare entity in pediatric patients and should be considered in the differential diagnosis of persistent midline penile base or suprapubic discharge. Despite its benign course, proper identification and complete surgical excision are essential to prevent misdiagnosis and ensure definitive treatment. Increased awareness and reporting of such cases are important to improve understanding of this uncommon condition.
Keywords: prepubic sinus, urethral duplication, urethra
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