Abstract
Purpose
To evaluate the utility of transutricular seminal vesiculoscopy as a diagnostic and therapeutic option for symptomatic midline cyst of the prostate in patients with hematospermia and symptoms associated with prostatitis.
Materials and methods
From January 2005 to July 2013, 61 patients with symptomatic (hematospermia, pain on ejaculation, scrotal discomfort) midline cyst of the prostate, who did not improve with medication within a 4-week period, were included. Diagnosis of a midline cyst of the prostate was based on an anechoic round or spheroid-shaped lesion in the median, above the level of the verumontanum, extending into the prostatic base on transrectal ultrasonography (TRUS). All patients underwent transutricular seminal vesiculoscopy using a 9.0 Fr rigid ureteroscope and Bugbee electrode. Medical records, the Chronic Prostatitis Symptom Index (NIH-CPSI), and TRUS were used for assessment for more than 3 months after the procedure.
Results
Of the 61 patients, 32 (52.4 %) had hematospermia, 20 (32.7 %) had symptoms associated with chronic pelvic pain syndrome, such as perineal pain, scrotal discomfort, and testicular pain, and nine (14.7 %) patients had ejaculatory disturbances, such as painful or uncomfortable ejaculation and anejaculation as major complaints/symptoms. In endoscopic findings, hemorrhage was present in the dilation of the prostatic utricle and in the seminal vesicle in 11 (18.0 %) and 21 (34.4 %) of the patients, respectively. Calculi were found in the dilation of the prostatic utricle and in the seminal vesicle in 12 (19.7 %) and six (9.8 %), respectively. Hematospermia resolved in 29 of 32 (90.6 %) patients after transutricular seminal vesiculoscopy. In 29 patients with chronic pelvic pain syndrome and ejaculatory disturbances, NIH-CPSI scores improved, from 19.0 ± 3.8 to 11.8 ± 3.6 (p < 0.001), after treatment. The pain domain and quality-of-life domain scores of the NIH-CPSI were better postsurgery than presurgery (p < 0.001). Acute epididymitis, as a postoperative complication, was observed in two patients (3.3 %).
Conclusions
There are various endoscopic findings in the dilation of prostatic utricle and seminal vesicle such as hemorrhage, calculi or/and purulent material in the patients with midline cyst of the prostate. The role of transutricular seminal vesiculoscopy in reducing symptoms may be mediated through the effects of endoscopic fenestration, removal of blood clots, calculi, or whitish debris and/or electrocautery of intracystic hemorrhage. This endoscopic technique enables useful diagnostic and therapeutic approaches for symptomatic midline cysts of the prostate.
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References
Hamper UM, Epstein JI, Sheth S, Walsh PC, Sanders RC (1990) Cystic lesions of the prostate gland. A sonographic–pathologic correlation. J Ultrasound Med 9:395
Coppens L (1997) Diagnosis and treatment of obstructive seminal vesicle pathology. Acta Urol Belg 65:11
Dik P, Lock TM, Schrier BP, Zeijlemaker BY, Boon TA (1996) Transurethral marsupialization of a medial prostatic cyst in patients with prostatitis-like symptoms. J Urol 155:1301
Berényi P, Szokoly V (1992) Suprapubic transvesical puncture and sclerotization of a müllerian duct cyst under US guidance. Urol Radiol 13:194
Monfort G (1982) Transvesical approach to utricular cysts. J Pediatr Surg 17:406
Yeung CK, Shhoe JDY, Tam YH, Lee KH (2001) Laparoscopic excision of prostatic utricles in children. BJU Int 87:505
Turek PJ, Jorge OM, Larry IL (1996) Semen parameters before and after transurethral surgery for ejaculatory duct obstruction. J Urol 155:1291
Galosi A, Montironi R, Fabiani A, Lacetera V, Gallé G, Muzzonigro G (2009) Cystic lesions of the prostate gland: an ultrasound classification with pathological correlation. J Urol 181:647
Furuya R, Furuya S, Kato H, Saitoh N, Takahash S, Tsukamoto T (2008) New classification of midline cysts of the prostate in adults via a transrectal ultrasonography-guided opacification and dye-injection study. BJU Int 102:475
Lin J, Wu H, Wang J, Le M, Yu H, Zhou H (2012) Ectopic opening of cystic dilatation of the ejaculatory duct into enlarged prostatic utricle. J Androl 33:574
Gomes A, FreitasFilho L, Leão JQS, Heinisch A, Carnevale J (2007) Ectopic opening of the vas deferens into a Müllerian duct cyst. J Pediatr Urol 3:151
Kato H, Komiyama I, Maejima T, Nishizawa O (2002) Histopathological study of the müllerian duct remnant: clarification of disease categories and terminology. J Urol 167:133
McMahon S (1938) An anatomical study by injection technique of the ejaculatory ducts and their relations. J Anat 72:556
Fisch H, Kang Y, Johnson C, Goluboff E (2002) Ejaculatory duct obstruction. Curr Opin Urol 12:509
Furuya S, Kato H (2005) A clinical entity of cystic dilatation of the utricle associated with hemospermia. J Urol 174:1039
Yang S, Rha K, Byon S, Kim J (2002) Transutricular seminal vesiculoscopy. J Endourol 16:343
Kang PM, Chung JI (2009) Effectiveness of transurethral coagulation and incision of ejaculatory duct for hematospermia caused by ejaculatory duct cyst and obstruction. Korean J Urol 50:272
Author contribution
Kang conceptualized, designed, drafted, statistically analyzed the manuscript; Seo acquired, analyzed and interpreted the manuscript; Yoon critically revised the manuscript for scientific and factual content; Chung conceptualized, designed and supervised the manuscript.
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Kang, P.M., Seo, W.I., Yoon, J.H. et al. Transutricular seminal vesiculoscopy in the management of symptomatic midline cyst of the prostate. World J Urol 34, 985–992 (2016). https://doi.org/10.1007/s00345-015-1689-y
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DOI: https://doi.org/10.1007/s00345-015-1689-y