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CASE REPORT
Year : 2006  |  Volume : 22  |  Issue : 1  |  Page : 64-65
 

Giant seminal vesicle cyst with ipsilateral hypoplastic kidney: Report of a case with review of literature


Department of Urology, Medical College and Hospital, *CT Scan Unit, IPGMER, Kolkata - 73, India

Correspondence Address:
Dilip Kumar Pal
Vinayak Garden, Flat No- A/3D, 41, Simla Road, Kolkata - 700 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.24660

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   Abstract 

We report a case of a congenital seminal vesicle cyst with ipsilateral hypoplastic kidney in a 51 year-old Indian man presenting with features of bladder outlet obstruction. Abdominal and pelvic Ultrasonography (USG), computed tomography revealed a retrovesical cystic mass measuring 10cm x 9cm with indentations over the left infero-lateral wall of the urinary bladder. On USG and radionuclide renal scanning the ipsilateral kidney was not found, which was located only on the CT scan. The cyst and the hypoplastic kidney was excised with an uneventful recovery.


Keywords: Congenital anomaly, hypoplastic kidney, seminal vesicle cyst


How to cite this article:
Pal DK, Bag AK, Sarkar S. Giant seminal vesicle cyst with ipsilateral hypoplastic kidney: Report of a case with review of literature. Indian J Urol 2006;22:64-5

How to cite this URL:
Pal DK, Bag AK, Sarkar S. Giant seminal vesicle cyst with ipsilateral hypoplastic kidney: Report of a case with review of literature. Indian J Urol [serial online] 2006 [cited 2019 Mar 23];22:64-5. Available from: http://www.indianjurol.com/text.asp?2006/22/1/64/24660



   Introduction Top


Seminal vesicle cyst is a rare urological problem.[1],[2],[3] Since the first case reported by Zinner in 1941 only 60 cases of seminal vesicle cyst associated with renoureteral agenesis were reported.[1] Here we report a giant seminal vesicle cyst with hypoplastic left kidney presented with chronic urinary retention. Association of seminal vesicle cyst with hyploplastic kidney was not reported before as best of our knowledge; all reported cases were associated with renal agenesis, not hypoplasia. A brief review of literature is discussed.


   Case Report Top


A 51-year-old man presented with acute urinary retension. On examination urinary bladder was palpable up to the umbilicus. After catheterization a vague lump was palpable on the left side of suprapubic region. On DRE prostate was of normal size, but a cystic mass was palpable arising from the upper boarder of the prostate. He was normotensive, normoglycaemic, with normal renal biochemical parameters. Abdominal and pelvic ultrasonography could not find out the left kidney with presence of a retrovesical hypoechoic mass measuring 10x9x7 cm. A radionuclide scan failed to detect the presence of any functioning renal tissue on the left side. A contrast CT scan showed a nonenhancing retrovesical cystic mass (10 cm x 9 cm x 6.5 cm) with extrinsic compression on the left inferolateral wall of the urinary bladder [Figure - 1] and presence of a nonexcreting small hypoplastic kidney-like stucture [Figure - 2] on the same side. Cystoscopy demonstrated an elevated bladder neck with smooth bulging of the left lateral wall of the urinary bladder. On exploration a large cystic seminal vesicle was identified on the left side. The mass was dissected, ligating the vas, till the opening of the ejaculatory duct. The left lower ureter was not found on through searching. An exploration of the left renal area was done in the same time for exploration and confirmation of the kidneylike mass which unexpectedly reveals a rudimentary (3 cm) proximal part of the ureter. The kidney like structure including the rudimentary ureter was dissected out.The histopathology of the resected specimenshowed dysplastic renal tubules and fibrous tissue. The post operative period was smooth and a follow up ultrasound till one year did not show any recurrence of the cyst.


   Discussion Top


Though the seminal vesicle cyst is a rare urological problem, but with advent of modern imaging techniques, such as transrectal ultrasound, computed tomography and magnetic resonance imaging has made the diagnosis more frequent.[1] The genesis of such cysts is usually congenital due to maldevelopment of the mesonephric duct between the 4th and 13th week of intraembryonic life.[2] The embryologic explanation between seminal vesicle cyst and ipsilateral renoureteral agenesis is based on common development of both the structures from the mesonephric duct. If the ureteral bud fails to develop, the ipsilateral kidney is absent and the seminal vesicle can not develop properly. Sometimes the ureter may open into the seminal vesicle which may contribute the cystic component.[3] Ureteral remnants are present only in 14% of the cases.[4] Some cysts are acquired due to blockage of the ejaculatory duct due to adjacent inflammation such as prostatitis.[3] In acquired cases there is free communication between seminal vesicle and vas, possible explanation may be due to blockage of the ejaculatory duct leading to retension of seminal fluid causing cyst formation.[3] Usually the disease is discovered at the late second or third decade of life at the time of maximum sexual activity[4] though this case was presented pretty late in the sixth decade. The common symptoms are dysuria, frequency, perineal pain, epididymitis, pain following ejaculation and scrotal pain.[4] The differential diagnosis is Mullerian duct cyst where no spermatozoa can be found from the cyst fluid.[3] Spontaneous rupture of the cyst into the rectum or infection leading to seminal vesicle abscess is a recognized complication.[5] Choice of treatment depends upon the severity of symptoms which is usually correlated with size of the cyst. Cyst aspiration, transurethral deroofing of the cyst, laparoscopic excision of the cyst has been recommended[2],[3],[4] but most of the large cases have been treated by open excision when symptoms are troublesome and the cyst is large enough.[4]

 
   References Top

1.Selli C, Bartoletti R, Travaglini F, Doggweiler R, Rizzo M. Surgical treatment of bilateral large seminal vesicle cysts associated with unilateral renoureteral agenesis. Urol Int 1997;58:66-8.  Back to cited text no. 1  [PUBMED]  
2.Gallmetzer J, Gozzi C, Dolif R, Salsa A. Seminal vesicle cyst (and ejaculatory duct cyst) with ipsilateral renal agenesis. Report of five cases and review of literature. Minerva Urol Nephrol 1999;51:27-31.  Back to cited text no. 2  [PUBMED]  
3.Beeby DI. Seminal vesicle cyst associated with ipsilateral renal agenesis. Case report and review of literature. J Urol 1974;112:120-2.  Back to cited text no. 3  [PUBMED]  
4.Van den Ouden D, Bloom JH, Bangma C, de spiegeleer AH. Diagnosis and management of seminal vesicle cysts associated with ipsilateral renal agenesis: A pooled analysis of 52 cases. Eur Urol 1998;33;433-40.  Back to cited text no. 4    
5.Lodh U, Kumar S. Infected seminal vesicle cyst with spontaneous rapture into the rectum. Indian J Urol 1996;12:79-81.  Back to cited text no. 5    


    Figures

  [Figure - 1], [Figure - 2]

This article has been cited by
1 The giant seminal vesicle cyst: Magnetic resonance imaging findings
Battal, B. and Akgun, V. and Karaman, B.
JBR-BTR. 2012; 95(1): 38
[Pubmed]



 

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    Abstract
    Introduction
    Case Report
    Discussion
    References
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