Primary seminal vesicle adenocarcinoma with a history of seminal vesicle cyst:A case report and review of literature

BACKGROUND Primary seminal vesicle adenocarcinoma is a rare malignancy that is difficult to diagnose.CASE SUMMARY A 54-year-old man with an 18-year history of a seminal vesicle cyst presented with worsening hematospermia that had persisted for one month.Dynamic contrast-enhanced computed tomography and pelvic magnetic resonance imaging indicated a mass with a cystic-solid component.Robot-assisted seminal vesicle tumor resection was performed,and primary seminal vesicle adenocarcinoma was confirmed pathologically.The patient received pelvic radiotherapy for six weeks,and to date,no evidence of recurrence has been found.CONCLUSION Seminal vesicle cysts should be monitored long-term.Seminal vesicle adenocarcinoma presents with non-specific symptoms and can be diagnosed by immunohistochemistry.

Acute diffuse peritonitis secondary to a seminal vesicle abscess:A case report

BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritonitis(ADP)induced by SVA is unusual.CASE SUMMARY We report a case of a left SVA in a male patient complicated with pelvic abscess,ADP,multiple organ dysfunction syndrome,infectious shock,bacteremia,and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter.The patient received a course of morinidazole+cefminol antibiotics but showed no obvious relief,so the perineal SVA underwent puncture drainage and abdominal abscess drainage+appendectomy was performed.The operations were successful.After the operation,anti-infection,anti-shock,and nutritional support treatments were continued and various laboratory indicators were regularly reviewed.The patient was discharged from the hospital after recovery.This disease is a challenge for the clinician because of the unusual spreading path of the abscess.Moreover,appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary,especially when the primary focus cannot be determined.CONCLUSION The etiology of ADP varies,but acute peritonitis secondary to SVA is very rare.In this patient,the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens,forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer.Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity,and appendix involvement led to extraserous suppurative inflammation.In clinical practice,surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.

Function of seminal vesicles and their role on male fertility

The present review has been designed to update the recent developments on the function of seminal vesicles andtheir role on male fertility. It is indicated that the true corrected fructose level is a simple method for the assessment ofthe seminal vesicular function. Measurement of seminal fructose used universally as a marker of the seminal vesiclefunction is not an appropriate approach due to its inverse relationship with the sperm count. The true corrected fructosedefined as [log. motile sperm concentration] multiplied by [seminal fructose concentration] has been shown to be abetter marker of the seminal vesicle function. Seminal vesicular secretion is important for semen coagulation, sperm motility, and stability of sperm chromatinand suppression of the immune activity in the female reproductive tract. In conclusion, the function of seminal vesicle is important for fertility. Parameters as sperm motility, sperm chro-matin stability, and immuno-protection may be changed in case of its hypofunction. (Asian J Androl 2001 Dec; 3:251 -258)

Seminal vesicles and diabetic neuropathy： ultrasound evaluation in patients with couple infertility and different levels of glycaemic control

The aim of this study was to evaluate the ultrasound characteristics of the seminal vesicles （SVs） of infertile patients with diabetes mellitus （DM） and diabetic neuropathy （DN） and to investigate possible changes in ultrasound characteristics related to glycaemic control. To accomplish this, 45 infertile patients with type 2 DM and symptomatic DN were selected. Twenty healthy fertile men and 20 patients with idiopathic oligoasthenoteratozoospermia without DM represented the control groups. DM patients were arbitrarily divided into three groups according to glycaemic control level （A=glycosylated haemoglobin 〈7%; B =glycosylated haemoglobin between 7% and 10%; C=glycosylated haemoglobin 〉 10%）. Patients underwent prostate-vesicular transrectal ultrasonography and sperm analysis. The following SV ultrasound parameters were recorded： （i） body antero-posterior diameter （APD）; （ii） fundus APD; （iii） parietal thicknesses of the right and left SVs; and （iv） the number of polycyclic areas within both SVs. We then calculated the following parameters： （i） fundus/body （F/B） ratio; （ii） difference of the parietal thickness between the right and the left SV; and （iii） pre- and post-ejaculatory APD difference. All DM patients had a higher FIB ratio compared to controls （P〈0.05）. Group C had a higher FIB ratio compared to the other DM groups （P〈0.05）. All DM patients had a lower pre- and post-ejaculatory difference of the body SV APD compared to controls （P〈0.05）. Groups A and B had a similar pre- and post-ejaculatory difference of the body SV APD, whereas this difference was lower in Group C （P〈0.05）. In conclusion, infertile DM patients with DN showed peculiar SV ultrasound features suggestive of functional atony, and low glycaemic control was associated with greater expression of these features.

The performance of transrectal ultrasound in the diagnosis of seminal vesicle defects： a comparison with magnetic resonance imaging

Obstructive azoospermia （OA） is one of the most common causes of male infertility. Transrectal ultrasound （TRUS） has been used to diagnose OA for many years. From 2009 to 2013, we evaluated a prospective cohort of 1249 patients with suspected OA using TRUS. It was found that dilation of the ejaculatory duct （ED） （29.9%, 374/1249） was the most common cause of OA, followed by seminal vesicle （SV） abnormalities （28.5%, 356/1249）. A total of 237 patients were diagnosed with congenital defects （agenesis and/or hypoplasia） of the SV, constituting more than half of the cases of SV disease in OA （19.0%, 237/1249）. In contrast to ED, congenital defects of the SV could not be corrected with surgical treatment. Therefore, it is meaningful to compare TRUS and magnetic resonance imaging （MRI） for accurate diagnosis of SV defects. Among our patients, 30 with agenesis or/and hypoplasia of the SV on TRUS were further evaluated using pelvic MRI within 2 years, with the objective of verifying the TRUS results. The concordance rate for diagnosing congenital defects of the SV was 73.3% （22/30）. We concluded that TRUS is a reliable and convenient method for diagnosing agenesis or hypoplasia of the SV in OA patients with a high concordance with MRI while MRI is useful in patients with inconclusive TRUS findings.

Laparoscopic treatment of a calcium fluorophosphate stone within a seminal vesicle cyst

Stones in the seminal vesicles are extremely rare. We present a 62-year-old patient with a stone within a seminal vesicle cyst, who was cured by laparoscopic treatment. The operative time was 80 rnin, and the estimated blood loss was 90 mL. Scanning electron microscope examination of the stone showed a compact crystal image externally and sparse spherical crystal structure in kernel. Composition of the stone was calcium fluorophosphate on X-ray diffractometer. The follow-up time was 15 months with no recurrence of cyst or stone. To our knowledge, this case is the first to describe laparoscopic removal of a stone within a seminal vesicle cyst, and the first to describe calcium fluorophosphate as the composition of seminal vesicle stones. （Asian JAndro12008 Mar; 10： 337-340）

Rectoseminal vesicle fistula after radical surgery for rectal cancer:Four case reports and a literature review

BACKGROUND A rectoseminal vesicle fistula(RSVF)is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage(AL).Limited literature documenting this rare complication is available.We report four such cases and review the literature to investigate the etiology,clinical manifestations,and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder.CASE SUMMARY Four cases of RSVF were presented and summarized,and a further 12 cases selected from the literature were discussed.The main clinical symptoms in these patients were pneumaturia,fever,scrotal swelling and pain,anal pain,orchitis,diarrhea,dysuria,epididymitis and fecaluria.Imaging methods such as pelvic Xray,computed tomography(CT),sinus radiography,barium enema and other techniques confirmed the diagnosis.CT was the imaging modality of choice.In cases presenting with reduced levels of AL,minimal surrounding inflammation,and controlled infection,the RSVF was conservatively treated by urethral catheterization,antibiotics administration and parenteral nutrition.In cases of severe RSVF,incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula.CONCLUSION This study provides an extensive analysis of RSVF,and outlines,summarizes and examines the causes,clinical manifestations,diagnostic procedures and treatment options,in order to prevent misdiagnosis and treatment errors.

Solitary seminal vesicle metastasis from ileal adenocarcinoma presenting with hematospermia:A case report

BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection,his subsequent management and outcome.CASE SUMMARY A 46-year-old man presented with recurrent episodes of painless hematospermia.This was not associated with any lower urinary tract symptoms.He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation,and underwent partial ileectomy and lymphadenectomy 4 years ago.Subsequent investigations included positronemission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle.Laparoscopic leftsided vesiculectomy was carried out.Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative,and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary.The patient had an uneventful post-operative recovery.He received adjuvant chemoradiotherapy following surgery.He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery.CONCLUSION Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.

A Pelvic Free-Floating “Intraperitoneal Mice” Mimicking Seminal Vesicle Malignancy: A Case Report

Peritoneal loose bodies or “peritoneal mice” are rare well circumscribed benign masses composed of free-floating organized fat necrosis. They are usually asymptomatic and found as “incidentalomas” during Imaging. Their pathogenesis is not well known. We report a rare case of giant intraperitoneal mice which was clinically misdiagnosed as left seminal vesicle malignancy. A review of the literature is also presented.

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.

Neoadjuvent androgen deprivation for seminal vesicle reduction:The optimal portion of seminal vesicle included in the high-dose CTV in localized prostate cancer radiotherapy

Objective:To clarify the length and volume reduction of seminal vesicles(SVs)after neo-adjuvant hormonal therapy(NHT),in order to help contour the optimal SV included into high-dose clinical target volume(CTV)for radiotherapy in intermediate-and high-risk patients.Methods:MR images both before and after NHT(5.3±2.2 months)were collected from thirty-one patients with cT2-4N0M0 prostate cancer.SV volume was measured in axial T1WI,while SV length was obtained in a reconstructed oblique coronary plane through its long axial from a 3D sequence.Results:SVs showed evident reduction both in length and volume(length:median 12.1%,range 4.0%–28.0%;volume:median 39.9%,range 9.4%–66.2%).For SVs with and without MR detected involvement,length shortening were(16.7±4.8)%and(11.1±4.4)%(P<0.001);for involved SVs and lesions,volume reduction were(41.0±16.0)%and(66.3±14.4)%,respectively(P<0.001),both indicating a more sensitive response to NHT of the involved portion than normal SV.Conclusions:Both volume and length of the SV will be reduced after receiving NHT.Besides,the invaded segments shrink more than normal SV tissue,indicating that SV portion included within the CTV can be reduced.

Transurethral seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle stones

Background Seminal vesicle stones are one of the main causes of persistent hemospermia. Treatment requires removal of the stone, generally through open vesiculectomy. The purpose of this study was to apply a transurethral seminal vesiculoscopy for diagnosis and treatment of the seminal vesicle stones with an ureteroscope. We assessed whether this transurethral endoscopic technique is feasible and effective in the diagnosis and treatment of the seminal vesicle stones with intractable hemospermia. Methods Totally 12 patients with intractable hemospermia underwent transurethral seminal vesiculoscopy through the distal seminal tracts using a 7.3-French rigid ureteroscope. Age of patients ranged from 25 to 57 years （mean age （43.7±10.5） years）. The patients＇ symptoms ranged in duration from 4 to 180 months （mean duration （47.8±45.3） months）. All patients underwent transrectal ultrasonography, pelvic computed tomography or magnetic resonance imaging before the operation. Positive imaging findings were observed in patients with seminal vesicle stones and dilated seminal vesicle size. A 7.3-French rigid ureteroscope entered the lumen of the verumontanum, and then the seminal vesicle under direct vision. Seminal vesicle stones were found unilaterally in 11 cases and bilaterally in one case. Results All 12 patients successfully underwent transurethral seminal vesiculoscopy. The seminal vesicle interior with single or multiple yellowish stones ranging from 1 to 5 mm in diameter was clearly visible. All the stones were easily fragmented and endoscopically removed using a grasper. The operative time was 30 to 120 minutes （mean （49±22） minutes）. The mean follow-up period was （6.9±3.0） months （range 3-13 months）. Symptoms of hemospermia disappeared after one month in 10 patients and after three months in two patients. Three patients with painful ejaculation could completely be relieved postoperation. There was also improvement in one patient with erectile dysfunction. There were no postoperative complications. Conclusions Transurethral seminal vesiculoscopy is safe and effective in the diagnosis and treatment of seminal vesicle stones. This endoscopic technique can be performed with minimal complications.

Clinical outcomes of transperitoneal laparoscopic unroofing and fenestration under seminal vesiculoscopy for seminal vesicle cysts

Symptomatic seminal vesicle cysts （SVCs）, especially those of a large size, can be removed by surgical treatments. Currently, open surgeries for SVC are rarely performed due to their extensive surgical trauma, and minimally invasive surgical therapies for treating seminal vesicle cysts are still in the early stages. In addition, relevant studies are mostly confined to case reports. In this study, we retrospectively reviewed 53 patients who had received transperitoneal laparoscopic unroofing or fenestration under seminal vesiculoscopy for SVC in our institution. Both surgeries decreased the cyst volume to a significant extent; however, according to the remnant lesion size after rechecking images, seminal vesiculoscopic fenestration tended to have a higher recurrence than laparoscopic unroofing. Regarding complications, two individuals in the laparoscopic unroofing group experienced ureteral injury and rectal injury, while patients in the fenestration group only had temporary hemospermia, which indicates that fenestration surgery tends to have less severe complications than laparoscopic unroofing. There was no solid evidence confirming semen improvement after these surgical therapies in our study. Future studies with a prospective design, larger sample size, and longer follow-up period are required to verify and further explore our findings.

Relation of size of seminal vesicles on ultrasound to premature ejaculation

Myriad biological factors have been proposed to explain premature ejaculation （PE）. However, data correlating PE with seminal vesicles （SVs） are sparse. The study aimed to evaluate the relationship between the size of SV and PE. The cross-sectional study included 44 outpatients with PE and 44 volunteers without PE, and the size of SV was compared. Self-estimated intravaginal ejaculatory latency time, the Premature Ejaculation Diagnostic Tool （PEDT）, the International Index of Erectile Function-15, and the National Institutes of Health-Chronic Prostatitis Symptom Index were used for assessment of symptoms. Compared to the control group, the PE group had significantly higher mean anterior-posterior diameter （APD） of SV （P 〈 0.001）. The optimal mean APD of SV cutoff level was 9.25 mm for PE. In the PE group, PEDT was also higher with a mean APD of SV ≥9.25 mm compared with mean APD of SV 〈9.25 mm. PEDT was significantly correlated with the mean APD of SV （r = 0.326, P = 0.031）. The seminal plasma proteins were compared between six PE and six matched control cases by mass spectrometry and it was shown that 102 proteins were at least 1.5-fold up- or down-regulated. Among them, GGT1, LAMC1, and APP were significantly higher in the PE group. These results indicated that men with a larger mean APD of SV might have a higher PEDT score. Transrectal ultrasound of SV should be considered in the evaluation of patients with premature ejaculation. SV might be a potential target for the treatment of patients with PE and ultrasound change in SV.

Neurilemmoma of a seminal vesicle

Neurilemmoma, also named Schwannoma, is usually a benign tumour composed of Schwann cells. It is commonly located in the retroperitoneum, mediastinum, head and neck, and is rarely seen in the genitourinary organs. Only cases of neurilemmoma originating from the seminal vesicle have been reported. Here we present the third case.

mpact of antioxidants on seminal vesicles function ind fertilizing potential in diabetic rats

Diabetes mellitus significantly affects the male reproduction and sexual function. In the present study, we investigated the diabetes-induced dysfunction of seminal vesicles （SVs） in the diabetes-rat model and the role of antioxidants. Streptozotocin-induced diabetes after 4 weeks caused smaller size of the organs, hypercontractility, histological abnormalities, increased concentrations of malondialdehyde in the serum and tissue, overexpression of oxidative stress markers, and cleaved caspase-3 as identified by immunohistochemistry in the SVs. In addition, diabetes resulted in deceased levels of serum testosterone and no newborns after the mating studies. Antioxidants significantly normalized all the above parameters, except for the severely decreased serum testosterone levels and the negative outcome of the mating studies. The present study gives evidence for the important role of diabetes-induced oxidative stress in the function and structure of these androgen-dependent organs. Antioxidants may be a promising supplementary therapy for diabetic male patients to alleviate ejaculatory disorders but alone is not efficient treatment for the mitigation of infertility.

Stimulating effects of quercetin on sperm quality and reproductive organs in adult male rats

Aim： To investigate effects of quercetin on weight and histology of testis and accessory sex organs and on sperm quality in adult male rats. Methods： Male Sprague-Dawley rats were injected s.c. with quercetin at the dose of 0, 30, 90, or 270 mg/kg body weight/day （hereafter abbreviated Q0, Q30, Q90 and Q270, respectively）, and each dose was administered for treatment durations of 3, 7 and 14 days. Results： From our study, it was found that the effects of quercetin on reproductive organs and sperm quality depended on the dose and duration of treatment. After Q270 treatment for 14 days, the weights of testes, epididymis and vas deferens were significantly increased, whereas the weights of seminal vesicle and prostate gland were significantly decreased, compared with those of Q0. The histological alteration of those organs was observed after Q270 treatment for 7 days as well as 14 days. The sperm motility, viability and concentration were significantly increased after Q90 and Q270 injections after both of 7 and 14 days. Changes in sperm quality were earlier and greater than those in sex organ histology and weight, respectively. Conclusion： Overall results indicate that quercetin might indirectly affect sperm quality through the stimulation of the sex organs, both at the cellular and organ levels, depending on the dose and the duration of treatment. Therefore, the use of quercetin as an alternative drug for treatment of male infertility should be considered. （Asian J Androl 2008 Mar. 10： 249-258）

Effect of nitrofurazone on the reproductive organs in adult male mice

Aim: To study the effect of 5-nitro-2-fumldehyde semicarbazone (nitrofurazone), a derivative of nitrofuran, onmale reproductive organs of Parkes (P) swain mice. Methods: Mice were given nitrofurazone orally at a dose of 64mg/kg body weight per day, for 10 and 20 days, and were killed 24 h and/or 56 days after the last treatment. Histo-logical appearance of testis, motility and number of spermatozoa in cauda epididymidis, and biochemical indices in epi-didymis and seminal vesicle were evaluated. Results: Histologically, testis showed marked regressive changes inthe seminiferous tubules in mice treated with nitrofurazone. Ten days after treatment, there was much depletion of germcells in the seminiferous tubules, and the germinal epithelium was lined mainly with Sertoli cells, spermatogonia, sper-matocytes, and a few round spermatids; intraepithelial vacuoles and multinucleated giant cells were also observed intubules. By 20 days, regressive changes in the seminiferous tubules were further pronounced, and pachytene spermato-cytes were the most advanced germ cells noticed in the tubules. In severe cases, the tubules were lined with a thin layerof Sertoli cells and spermatogonia. The treatment also caused marked reductions in the motility and number of sperma-tozoa in the cauda epididymidis, in weight and the level of fructose in the seminal vesicle, and in sialic acid level in theepididymis. Fifty six days after drag withdrawal, the alterations induced in the reproductive organs returned to controllevels. Conclusion: Our results suggest that nitrofurazone treatment in P mice induces marked alterations in themale reproductive organs, and that the alterations are reversible following cessation of treatment.(Asian J Androl 2001 Mar; 3: 39-44)

Castration-induced expression of caspase-1 in epithelia of accessory sex organs in male rats

Aim: As an attempt to clarify the molecular basis of castration-induced apoptosis, this study was undertaken todemonstrate the expression of caspase-1 in male accessory sex organs of rats. Methods and results; cDNA of ratcaspase-1 was cloned by reverse transcription-polymerase chain reaction from the ventral prostates. The open readingframe predicts 402 amino acids, which shows more than 91% and 63% identity to those of mouse and human, respec-tively. Northern analyses demonstrated the presence of castration-induced up-regulation of the 1.6 kb transcript in theventral prostate and the seminal vesicles. Finally, the authors demonstrated the caspase-1 transcripts in the epithelia ofthese tissues by in situ hybridization analyses. Conclusion; Castration induces the expression of caspase-1 tran-scripts in the epithelia of ventral prostate and seminal vesicle. These observations suggest a possible role of caspase-1 inapoptosis in male accessory sex organs.

Constraint Analysis and Bladder Wall Low-Dose-Constraint Reduction in Five-Fraction Urethra-Sparing Prostate SBRT

Aim: To compare and analyze dose constraints and target coverage results and to reduce Bladder Wall (Bwall) V18.12 for prostate Stereotactic-Body Radiation Therapy (SBRT) when Seminal Vesicles (SSVV) are included or not. Several indicators based on intersection volumes are obtained to predict constraint fulfillment. Background: Due to prostate’s low alpha-beta ratio and the possibility of increasing the therapeutic ratio several moderate and extreme hypofractionation schemes have been proposed. The scheme selected was a fivefraction urethra-sparing prostate SBRT. Materials and Methods: 150 patients divided into two groups according to the inclusion of SSVV in PTV or not were analyzed. Histograms, average values, standard deviations and degrees of fulfillment were obtained for each constraint or goal and group. A possible reduction of the Bwall V18.12 was addressed by re-optimizing fifty randomly chosen patients. Predictors of constraint fulfilling were obtained by using the intersections of Bwall and Rectum Wall (Rwall) with the PTV. Results: Significant differences in Rwall V32.62 and V29 were obtained when evaluating the influence of SSVV inclusion. A reduction of 12% in the Bwall V18.12 constraint was achieved without compromising coverage and OARs doses. No dependence on the inclusion of SSVV was found. Conclusions: Statistically significant differences have been found in Rwall intermediate-dose constraint when SSVV was included. A reduction of 12% in the Bwall V18.12 constraint has been achieved without compromising the PTV coverage and the rest of OARs constraints. Constraint fulfillment predictors could be useful to evaluate the feasibility of prostate SBRT prior to the planning process for every single patient.