Seminal vesicle cyst associated with ipsilateral renal agenesis

A case of seminal vesicle cyst associated with ipsilateral renal agenesis was experienced recently in our clinic. A 23-year-old male presented with a complaint of right hemiscrotal pain. Right kidney was not visualized by excretory urography. Cystoscopic examination revealed the absence of the right half of trigone and the right posterolateral wall bulging into the bladder, suggestive of an extrinsic mass displacing the bladder wall. Ultrasonography and computerized tomographic scan showed a large cystic mass in the right side of the retrovesical region. Exploratory operation disclosed that the cystic mass was part of the dilated seminal vesicle. Seminal vesiculectomy was done. Many cases of seminal vesicle cyst are associated with a simple or complex malformation of ipsilateral upper urinary tract (renal agenesis, dysplasia, hypoplasia and ectopic ureter). We speculate that most of the benign seminal vesicle cysts are formed as a congenital anomaly due to defective mesonephric duct development which causes concomitant malformations in the upper urinary tract.     

Hydatid cyst of the seminal vesicle

We present a rare case of a hydatid cyst involving the seminal vesicle of a 48-year-old man. Urinary retention was the initial symptom. Both imaging and clinical evaluation revealed a substantial retrovesical cystic mass. The histopathological report was 'hydatid cyst of the seminal vesicle'.     

Male genital malformations associated with right renal agenesis

A 30-year-old man visited our department complaining of discomfort on micturition. Hypoplasia of the bilateral epididymis, impalpable vas deferens, and prostatic tenderness were noted. Diagnostic imaging revealed agenesis of the right kidney, cystic dilation of the right seminal vesicle, and a prostatic utricle cyst. Examination of the genital tract confirmed aplasia of the left seminal vesicle and vas deferens and hypoplasia of the right seminal vesicle. On the basis of postoperative extravasation of contrast medium to the right epididymis, cystic dilation of the right seminal vesicle was diagnosed.     

Hematospermia: An investigation of the bleeding site and underlying lesions

Background : The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance.
Methods : Twenty-one patients aged 26–75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS).
Results : Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient.
Conclusion : Puncture of the seminal vesicles and/or müllerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.     

Mündung eines Megaureters mit aplastischer Niere in eine Samenblasenzyste

Unilateral cyst of the seminal vesicle, ipsilateral ectopic ureter, and ipsilateral renal aplasia are the components of a rare congenital abnormality affecting the male urogenital tract. The clinical picture is characterized by a retrovesical cystic tumor, which may cause nonspecific symptoms. Differential diagnosis includes cysts of the müllerian duct, the urogenital sinus/ejaculatory duct, and the prostate.We report a case of a left seminal vesicle cyst associated with aplasia of the left kidney in a 14-year-old boy. Preoperatively, an ipsilateral renal agenesis was suspected, but a renal aplasia with an ectopic urinary megaureter into the seminal vesicle was found intraoperatively. An 8-cm cystic left seminal vesicle and an ipsilateral renal aplasia was successfully removed by operative laparoscopy.The advantages of the laparoscopic approach over open surgery include excellent exposure of the deep pelvic structures, a short hospitalization, and a rapid recovery for the patient. We searched the literature to review the clinical presentation, diagnostic procedures, differential diagnosis, and therapeutic treatment options for this anomaly.     

Ectopic opening of cystic dilatation of the ejaculatory duct into enlarged prostatic utricle

A 28-year-old man was referred to our department for the management of recurrent hemospermia during the past 5 years. Genital examination and hormonal levels were normal. Semen analysis showed no change in volume and pH; however, hemospermia and asthenozoospermia were observed. Ultrasonography and computed tomography scan revealed the presence of a cystic lesion with calcification in the terminal part of seminal vesicles adjoining the prostate gland. The following vasography and endoscopic retrograde urethrography demonstrated 2 communicating cystic dilatations arising from the verumontanum. The diagnosis of cystic dilatation of the ejaculatory duct opening into an enlarged prostatic utricle was reached. Transurethral unroofing of the cyst was separately performed with a successful outcome. The characteristic of the 2 cystic dilatations was confirmed by pathologic examination. To the best of our knowledge, this is the first case of ectopic cystic dilatation of the ejaculatory duct opening into an enlarged prostatic utricle.     

Seminal vesicle cysts with unilateral renal agenesis and contralateral ureteral stenosis in a beta-thalassemic patient: an unknown association by incomplete development of the mesonephric duct

We report the case of a 13-year-old male patient with beta-thalassemic trait who presented for a colic pain. An ultrasound of the abdomen revealed absence of the right kidney with a complex hypoechogenic pelvic mass causing mild pressure on the posterior bladder wall. Urography showed hypertrophy of the left kidney with moderate ureteral enlargement of the distal third due to an insertion defect in the bladder suggestive of a primary segmental nonobstructing megaureter. MR studies showed right multilocular seminal vesicle cysts. One year later an MR examination of the pelvis showed an increase in size of seminal vesicle cysts and open surgery was performed to remove the cystic retrovesical mass. Our case represents a very rare association of seminal vesicle cysts, unilateral renal agenesis and alteration in contralateral ureteral insertion in a patient with beta-thalassemic trait.     

Histopathological study of the müllerian duct remnant: clarification of disease categories and terminology.

PURPOSE: We determined by histopathological studies whether there is an etiological difference in 2 distinct categories of müllerian duct remnant diseases. In addition, we clarified the nomenclature of these diseases. MATERIALS AND METHODS: We recently performed radical prostatectomy in a patient with prostate cancer associated incidentally with a so-called müllerian duct cyst in the prostatic midline. The specimen was examined by pathological and immunohistochemical testing with special attention to the relationship of the cyst and utricle. We also investigated the histology of so-called enlarged prostatic utricles or vagina masculinus extirpated from patients with severe hypospadias or intersex disorder. RESULTS: The round cyst removed with the prostate seemed to arise from the verumontanum and it contained fluid with a high concentration of prostate specific antigen. Histological and immunohistochemical examination of its lining epithelium demonstrated that cyst characteristics were identical to those of the prostatic utricle. On the other hand, pouches extirpated from patients with pediatric problems were lined by squamous epithelium. CONCLUSIONS: The so-called müllerian duct cyst appeared to originate from the prostatic utricle, and so should be termed a utricular cyst or cystic utricle. Conversely the so-called enlarged prostatic utricle should be termed a vagina masculinus or male vagina. The term müllerian duct remnant, which would include these 2 abnormalities, may usefully be replaced by the term utricular abnormalities.     

Ureteral ectopia presenting as epididymitis and infertility

A thirty-two-year-old man presented with a history of infertility, recurrent epididymitis, and a fluctuant pelvic mass on rectal examination. Preoperative evaluation disclosed a nonvisualized right kidney and a multiloculated cystic lesion in the pelvis. The intravenous pyelogram suggested a ureterocele on the right side. A cystic pelvic mass was noted on ultrasound and computed tomography. A dysplastic right kidney with an ectopic ureter inserting into a cystic seminal vesicle was found at surgical exploration.     

A case of ectopic prostatic tissue in urinary bladder and uretero-seminal vesicle fistula with ipsilateral aplastic kidney

A case of ectopic prostatic tissue in urinary bladder and uretero-seminal vesicle fistula with ipsilateral aplastic kidney is reported. A 29-year-old man was admitted to our hospital for residual sensation and perineal pain. Ultrasound examination revealed a cystic change in the right side of urinary bladder. C.T. and M.R.I. revealed a defect of a right kidney and ipsilateral ureteral dilation and seminal vesicle swelling. A cystscopy under lumbar anesthesia revealed a edematous cystic change of the right side of trigone and defect of the right ureteral orifice. Trans urethral resection of the wall of urinary bladder was simultaneously performed. And the contents of the cyst were sperum and old red blood cells. A retrograde ureterograph showed blind-ending ureter at L5 level and seminal vesicle swelling. A resected bladder tissue contained prostatic tissue. After operation he was free from complaints. Uretero-seminal vesicle fistula with ipsilater aplastic kidney is rare disease. In addition a case complicated ectopic prostatic tissue in urinary bladder was not reported in Japanese medical literature.     

Ectopic Prostatic Tissue Outside the Urinary Tract: A Case Report

A 64-year-old man with a 4-month history of dysuria and urinary frequency had a mass behind the bladder. The preoperative diagnosis was a tumor of the left seminal vesicle, but a histologic examination revealed benign prostatic tissue. This is the seventh reported case of ectopic prostatic tissue situated outside the urinary tract.     

A case of seminal vesicle cyst due to the obstruction of the ejaculatory duct: possible association with prostate cancer

We report a case of a seminal vesicle cyst supposed to be associated with prostate cancer in a 79-year-old Japanese man presenting with urinary retention. A fist-sized soft mass was palpated at the anterior wall of the rectum and serum prostate-specific antigen (PSA) was elevated to 59.8 ng/ml. Transrectal ultrasonography, computed tomography and magnetic resonance imaging revealed a retrovesical cystic mass measuring 7 cm in diameter and the absence of bilateral seminal vesicles. On vasography the lumen of the cystic lesion was visualized immediately, but the radiopaque fluid did not flow into the urethra. Transperineal prostate biopsy revealed moderately differentiated adenocarcinoma and puncture of the cyst revealed bloody fluid including sperm with a low PSA level. These findings strongly suggested that the mass was a seminal vesicle cyst caused by ejaculatory duct obstruction associated with prostate cancer. He has received endocrine therapy with goserelin acetate and bicalutamide for 6 months with no enlargement of the cystic lesion.     

Right renal agenesis and ureter ectopic abouchement in cystic dilation of seminal vesicle

The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach.     

巨大膀胱后异位前列腺1例报告并文献复习

目的探讨膀胱后异位前列腺的临床特征和治疗。方法回顾性分析1例膀胱后巨大实性异位前列腺的临床资料,并对既往文献进行复习。结果患者体检发现正常前列腺上方有一实性肿物,盆腔CT、盆腔MRI提示肿物直径约7cm,与膀胱后壁相邻。PSA为20ng/ml。术前行B超引导下经直肠肿物穿刺活检,病理结果为前列腺增生组织。手术切除肿物及前列腺。组织学和免疫组化检查结果证实肿物为前列腺组织。患者术后恢复顺利,PSA降为0。结论膀胱后异位前列腺极为罕见,手术切除是可靠的治疗方法。     

Magnetic Resonance Imaging in Hemospermia

Purpose

We evaluated the prostate and seminal tract with magnetic resonance imaging (MRI) in patients with hemospermia.

Materials and Methods

To evaluate the prostate and seminal tract in 17 patients 20 to 59 years old (mean age 44) with hemospermia we performed transrectal ultrasound and MRI using an endorectal surface coil with a 1.5 tesla unit. Mean duration of hemospermia was 32 months (1 week to 16 years).

Results

Abnormalities were noted on transrectal ultrasound in 15 of the 17 patients (88%) and on MRI in all. Of the 12 cases of hemorrhage 10 involved the seminal vesicle and 2 involved the ejaculatory duct. There were 12 cystic lesions, including 7 in the mullerian and 5 in the ejaculatory ducts. Of 19 cases calculi were detected in the prostate in 5, seminal vesicle in 8, and ejaculatory and mullerian duct cysts in 4 and 2, respectively. There was 1 case of prostatic atrophy and 1 wolffian duct anomaly associated with an ejaculatory duct cyst, ectopic ureterocele and absence of the left kidney.

Conclusions

MRI with an endorectal surface coil is a powerful modality for evaluating the seminal tracts of patients with hemospermia. It can be performed clinically when transrectal ultrasonography is not satisfactory.     

血精症病因探讨

血精症在泌尿男科的门诊中并非少见 ,大多数医生认为是由精囊炎引发的。本文综述近年来有关血精症出血部位和原发损害的研究进展 ,重点探讨血精症的一些少见原因 ,如精囊的扩张、囊肿、淀粉样变性、恶性肿瘤、副中肾管囊肿和异位的前列腺组织等 ,以期对临床工作有一定的启发     

Retention cyst of the prostate with projection of hyperplastic tissue: report of a case

A 46-year-old man presented at Kasukabe City Hospital because of urinary retention. Digital rectal examination revealed soft distended mass in the retrovesical space. Transrectal ultrasonography and computed tomography showed a retrovesical cystic lesion of 14 x 11 x 10 cm in size and a mass protruding into the cyst from posterior lobe of the prostate. The cyst and the mass were removed suprapubically. The cyst was filled with 400 ml of clear yellowish fluid containing acid-phosphatase and prostate-specific antigen in a high concentration, but no spermatozoa. The mass protruded posteriorily from the prostate. The wall of the cyst was partly lined with double layer of columnar epithelium. The histological examination of the mass showed marked nodular hyperplasia and dilated acini of the prostate gland was seen around the cyst. A diagnosis of retention cyst of the prostate and nodular hyperplasia of the prostate were made. Cysts of the prostate are uncommon and retention cysts protruded by markedly hyperplastic prostatic tissue are extremely rare.     

Accessory urethral channel communicating with the seminal vesicle

A rare variety of accessory urethra communicating with the left seminal vesicle is reported. Communication was demonstrated between the prostatic utricle and the right seminal vesicle, but not the left. Infection of the accessory channel was managed conservatively with anti-bacterial therapy. The classification, diagnosis, and treatment for this anomaly are discussed.     

Successful treatment of seminal vesicle calculi and prostatic utricle calculi by transurethral seminal vesiculoscopy

To investigate the outcomes of transurethral seminal vesiculoscopy (TSV) for the treatment of seminal vesicle calculi (SVC), prostatic utricle calculi (PUC) and combination of them, a retrospective review on 27 patients with SVC and/or PUC who complained of intractable haematospermia was conducted. Patient demographics, disease duration, operation time, stone location and complications were recorded. The calculi in the seminal vesicle and/or prostatic utricle were removed by holmium laser lithotripsy and/or basket extraction. The stone composition was determined in 19 of 27 patients using Infrared spectroscopy. The average age and disease duration of patients were 39.4 years and 23.1 months respectively. The mean operative time was 78.5 min. We detected SVC, SVC and PUC, and PUC in 59.3% (16/27), 33.3% (9/27) and 7.4% (2/27) patients respectively. The stones were mainly composed of calcium oxalate dehydrate (COD), carbonate apatite (CA), COD and calcium oxalate monohydrate (COM), CA and magnesium ammonium phosphate, CA and COM, and COD and uric acid in 42.1% (8/19), 21.1% (4/19), 15.8% (3/19), 15.8% (3/19), 5.3% (1/19) and 5.3% (1/19) cases respectively. No intraoperative and post-operative complications were noted. These results suggested that SVC and PUC can be diagnosed and treated using TSVs.     

Infected retroperitoneal cystic lymphangioma masquerading as psoas abscess

A 2-year-old male is described who presented with fever, fixed flexion deformity of the right hip and a tender mass in the right iliac fossa. A clinical diagnosis of psoas abscess was made. Abdominal ultrasound was suggestive of an echogenic retroperitoneal cyst but could not accurately determine the nature of the cyst. A contrast CT scan showed a retroperitoneal cyst. At laparotomy, a large retroperitoneal cyst containing turbid fluid was found and was excised completely. Histopathological examination was suggestive of cystic lymphangioma. Clinical presentation of retroperitoneal lymphangioma may be variable and misleading, therefore complex imaging studies are necessary in the evaluation of this condition.