Cysts

Cystic disease of the seminal vesicles is recognized more frequently in the era of cross-sectional imaging and transrectal ultrasonography. Seminal vesicle cysts are composed of a cuboidal or flattened epipthelium, fibrous wall, and contain whitish, thick fluid (12). When congenital, most men also have concomitant renal dysgenesis and ureteral ectopia (13). Acquired seminal vesicle cysts usually follow urinary tract infections or ejaculatory duct lithiasis and only rarely occur bilaterally (14,15). Seminal vesicle cysts can grow quite large (up to 15 cm) and have been reported to cause rectal obstruction (16). While prenatal ultrasonographic identification of a seminal vesicle cyst has been reported (17), most are diagnosed postpu-berty following an evaluation for pain, hematospermia, or infections (18,19).

Seminal vesicle cysts should be distinguished from mullerian duct cysts, which are found in the midline flanked on each side by a normal seminal vesicle. Since most seminal vesicle cysts are asymptomatic, no treatment is required.

When treatment is deemed necessary, cyst aspiration and transurethral resection of the ejaculatory duct are options but usually not effective (20,21). Surgical excision remains the definitive treatment.

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