Parameatal Urethral Cyst and Smegma Pearl in a Young Boy

A previously healthy uncircumcised 3-year-old boy with a 2-year history of asymptomatic swellings in the genitalia was encountered. The stream and frequency of urine were normal. Examination showed two cystic swellings lateral to the external urethral meatus without any signs of inflammation [Figure 1a]. He also had a 0.6 cm × 0.6 cm sized, round, soft, and yellowish nodule [Figure 1b]. Based on the clinical presentation, a diagnosis of parameatal urethral cyst and smegma pearl was made out. The parents were counseled regarding the benign nature of both the conditions and watchful expectancy for spontaneous resolution.Figure 1: (a) Two cysts lateral of the external urethral meatus (parameatal urethral cyst) and (b) A single well-defined, yellowish nodule (smegma pearl)Parameatal cyst is a rare urethral congenital disorder, with an unclear pathogenesis. Congenital fusion anomaly and obstruction of the paraurethral duct due to congenital cause, infection, or trauma have been postulated. The cyst develops at the lateral circumference of the meatus. Differential diagnosis includes pilosebaceous cyst, epidermoid cyst, and fibro-epithelial cyst. The possible treatment options are watchful waiting, needle aspiration, and complete surgical excision.[1] Smegma pearl develops in the glans of uncircumcised boys due to the collection of smegma. Clinically it appears as yellowish-white lumps, anywhere between the preputial membrane's attachment to the glans and the base of the glans penis. Smegma pearl can spontaneously resolve over time. Bimanual retraction and manual expression of smegma can be performed. However, it can lead to irritation of foreskin, paraphimosis, recurrence of phimosis, and ultimately recurrence of smegma pearl.[2] Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent (s)/guardian (s) of the patient. In the form, the parent (s)/guardian (s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.