Cysts of the ejaculatory system: a report of two cases

Retrovesical cysts in boys—case series and literature review

Background

Retrovesical cysts present with varying etiologies. We initiated this study to provide insights into retrovesical cysts in boys through a case series and systematic literature review and to aid in treatment alternatives.

Materials and methods

Case series of seven patients from the in-hospital register with a systematic literature review on retrovesical cysts in children.

Results

We identified seven patients from the in-hospital register during 2005–2020 and eighty-two patients from the literature review. The literature review showed that children’s retrovesical cysts are mainly asymptomatic before puberty. Those detected earlier in childhood present mostly with renal abnormalities. In our series, retrovesical cysts derived from three distinct etiologies with different treatment modalities. Asymptomatic cysts do not need excision and are to be followed up through puberty, but in the case of an ectopic ureter, nephroureterectomy is optional. Symptomatic retrovesical cysts may demand surgical excision. Ultrasonography is usually sufficient for diagnosis, but MRI provides better anatomical delineation and aids in surgical planning.

Conclusions

Retrovesical cysts in boys are benign conditions associated with abnormal development of the ureter and kidney. Ultrasonography is sufficient for diagnosis, with MRI giving further detail for surgical planning. Treatment consists of cyst excision, heminephrectomy/nephrectomy, transurethral canalization, or excision of prostatic utricle, depending on etiology. Asymptomatic cases are to be followed up through puberty, but in cases of an ectopic ureter, nephroureterectomy is preferred.

Etiologic classification, evaluation, and management of hematospermia

Hematospermia is defined by the presence of blood in the semen typically occurring in men younger than 40 years of age. Symptoms can occur due to a multitude of reasons, but are usually benign and self-limiting, requiring no additional treatment or evaluation. Despite this, the condition often impairs quality of life due to associated anxiety and must be taken seriously by the patient and the physician, particularly if recurrent, refractory, and painful. The etiology of hematospermia can be classified into inflammatory, infectious, lithiasis, cystic, obstructive, tumoral, vascular, traumatic, iatrogenic, and systemic origin. Alternatively, it can also be divided into subcategories based on anatomical origins such as prostate, bladder, spermatic cord, seminal vesicles, or epididymis. A complete history and physician examination, laboratory testing, and a variety of invasive and non-invasive imaging and instrumentation modalities can help to identify and treat the underlying pathology promptly.

Management of recurrent epididymitis in children: application of neurovascular sparing vas clipping in refractory cases

PURPOSE

To investigate the efficacy of therapeutic methods for recurrent epididymitis and neurovascular sparing vas clipping in refractory cases.

MATERIALS AND METHODS

Fifteen boys with recurrent epididymitis were enrolled: the first group (9) with primary structural anomalies and the second group (6) with voiding dysfunction without structural anomalies. Median age was 4 (29 months to 7 years) and 4.5 (6 months to 11 years) years, respectively. Mean follow up was 7.5 (2-11) and 5.2 (3.5-8) years, respectively.

RESULTS

Urethrovasal reflux was detected in all patients of the first group except one. Endoscopic injection of bulking agent was successfully applied in three patients with no recurrent epididymitis. No further episodes of epididymitis were reported after valve ablation or clean intermittent catheterization. In four non-responders, vas clipping was successfully undertaken. Voiding dysfunction was the possible etiology of epididymitis but with no obvious urethrovasal reflux in the second group. No further episodes of epididymitis occurred using bladder retraining and medications for detrusor and sphincter relaxation.

CONCLUSIONS

The results suggest that neurovascular sparing vas clipping can be used effectively in children with structural anomalies and urethrovasal reflux who have developed intractable epididymitis.

Acute scrotum caused by vasitis with abscess formation in children with lower urological anomalies

OBJECTIVES

The major causes of acute scrotum include testicular torsion, torsion of an appendix testis, and epididymo-orchitis. Recently, we experienced rare cases of acute scrotum caused by vasitis. Such a condition has not been previously reported in the literature so we summarize our patients with acute scrotum and discuss the pathogenesis of these rare cases.

METHODS

Thirty-two pediatric patients were admitted to our institutions with a diagnosis of acute scrotum between 1997 and 2008. The average age of the patients was 7.1 years. We summarize and review the clinical and pathologic features of 2 patients with vasitis with abscess formation.

RESULTS

The causes of acute scrotum included epididymitis, testicular torsion, and vasitis, among others. Testicular torsion was initially suspected in 23 of the patients. Twenty-three patients underwent emergency surgery, among whom 9 received orchidectomies. The initial diagnosis differed from the final diagnosis in 20 patients (62.5%). Two patients were diagnosed with vasitis. Both underwent emergency operations under a putative diagnosis of testicular torsion, and both were found to have hard tumorlike lesions in the scrotal portion during the surgery. These same 2 cases also suffered from lower urological anomalies, namely, hypospadias, posterior urethral valve, and Müllerian duct remnant.

CONCLUSIONS

Based on our experience, we propose that lower urological anomalies predispose children to vasitis and subsequent abscess formation. Pathologic conditions of this type have to be considered as potential causes of acute scrotum.

Successful treatment of recurrent epididymo-orchitis: Laparoscopic excision of the prostatic utricle

Prostatic utricle presenting with recurrent epididymo-orchitis is not uncommon. Excision of prostatic utricle is the treatment of choice. The various techniques described in literature suffer from the disadvantages of incomplete excision due to poor view. We report the successful laparoscopic excision of prostatic utricle in childhood.

Laparoscopic excision of extraprostatic ejaculatory duct cyst

Our experiences with laparoscopic excisions of symptomatic extraprostatic ejaculatory duct cysts (EDCs) are reported. Three laparoscopic excisions of extraprostatic EDCs performed by one urologist in 2003 and 2004 were retrospectively reviewed. Investigations included history, physical examination, image analysis, semen analysis, operation time, estimated blood loss, time of post-operative hospital stay, recovery time for regular activities, sexual function and complications. The laparoscopic excisions of EDCs were successful. The mean operation time was 105 min, and the mean estimated blood loss was 65 ml. The average post-operative hospital stay was 3.0 days. All patients exhibited normal erection and normal ejaculation. Improvement in semen quality was observed in two patients. All patients remained free of symptoms, and recurrence of EDCs was not detected on transrectal ultrasonography over a mean 32-month follow-up period. It is concluded that laparoscopic excision of an EDC is feasible and effective. Due to minimal invasiveness, short post-operative hospitalisation and rapid recovery, laparoscopic surgery is an attractive approach to managing symptomatic EDCs, especially for sizeable cysts or those including calculus.