Urology Case Reports 38 (2021) 101683 Available online 20 April 2021 2214-4420/© 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Functional medicine Bladder outlet obstruction secondary to Brunn’s cyst: A rare presentation in young man Alhareth Baarimah a, * , Abdullah Alsayed b , Ahmed Yamani b , Mohamed Aldawsari b , Shady Soliman b, c a Department of Urology, International Medical Center (IMC), Jeddah, Saudi Arabia b Department of Urology, Al Hada Armed Forces Hospital, Al Taif, Saudi Arabia c Department of Urology, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt A R T I C L E INFO Keywords: Brunn’s cyst Bladder neck Obstruction LUTS ABSTRACT Bladder outlet obstruction in younger men is usually secondary to urethral stricture disease. In the elderly, it is often a due to benign prostatic hyperplasia (BPH). Bladder obstruction secondary to Brunn’s Cyst should be considered as a differential diagnosis in young men with acute onset of obstructive symptoms and a cystic lesion at the bladder neck. We report a case of bladder outlet obstruction secondary to Brunn’s cyst in a 21-year-old male. Radiological investigations, cystoscopy, and histological examination revealed the rare pathology, which was managed by endoscopic de-roofng of the cyst. The symptoms resolved dramatically, with no recurrence. Introduction Brunn’s cyst, frst described by Israel Franco in 1988, is thought to be due to a pinched off portion of urothelial epithelium and is one of rare causes of bladder outlet obstruction. 1 The aim of this study was to report a 21-year-old male who presented with bladder outlet obstruction sec- ondary to a Brunn’s cyst and to highlight the clinical presentation, diagnosis, and treatment. To our knowledge, only six cases have been reported in the English literature. 2–4 Case presentation A 21-year-old male patient presented to the Urology clinic at Al Hada Armed Forces Hospital with a new onset of obstructive lower urinary tract symptoms (LUTS). The patient complained of obstructive symp- toms, including hesitancy, intermittency, weak stream, straining, and a sense of incomplete voiding for the previous three months. He had an International Prostate Symptom Score (IPSS) of 17 and a bother score of 4. He denied urinary incontinence, gross hematuria, or urinary tract infections. The patient was free of any other medical conditions, a nonsmoker, and not on any medication. A physical examination was unremarkable. Renal function, urinaly- sis, and urine culture were normal. Urofowmetry confrmed a low maximum fow rate (Qmax) of 8 mL/ s. A high post-void residual (PVR) of around 240 mL was noted. Upon further investigation, ultrasonography of the abdomen and pelvis revealed a small, well-defned cystic lesion at the bladder neck. Mag- netic resonance imaging (MRI) revealed that the cystic lesion was separated from the ureteral orifce (Fig. 1). A radiological diagnosis of Brunn’s cyst was confrmed based on the ultrasonography and MRI results. A cystoscopy examination showed that dome shaped cystic structure at the bladder neck between 3 and 6 o’clock was acting as a ball valve mechanism (Fig. 2). The patient underwent transurethral de roofng and resection of the cyst. The resection revealed no evidence of solid components (Fig. 3). At the one-month follow-up after the resection, his obstructive urinary tract symptoms were resolved; Urofow showed Qmax of 17 mL/s and his PVR was 0 mL. His fnal histopathology report showed no evidence of malignancy and was consistent with a Brunn’s cyst. Discussion Brunn’s cyst was frst described in 1988 by Israel Franco, who considered it to represent a pinched off portion of urothelial epithelium * Corresponding author. E-mail address: alhareth.adnan@gmail.com (A. Baarimah). Contents lists available at ScienceDirect Urology Case Reports journal homepage: http://www.elsevier.com/locate/eucr https://doi.org/10.1016/j.eucr.2021.101683 Received 22 March 2021; Received in revised form 10 April 2021; Accepted 13 April 2021