Transrectal ultrasound-guided transperineal and transrectal management of seminal vesicle abscesses

Seminal Vesicle Atrophy and Ejaculatory Dysfunction Secondary to Prostatic and Seminal Vesicle Abscesses

Seminal vesicle (SV) and prostatic abscesses are rare urological infections. However, their effect on sexual function remains unknown. In the present study, we encountered a case of SV atrophy and ejaculatory dysfunction (EjD) after conservative treatment. The patient was a 56-year-old man with fever who complained of pain during urination. He was diagnosed with SV and prostate abscesses and treated conservatively with antibiotics. One month after treatment, an EjD was observed, and magnetic resonance imaging revealed severe atrophy of the SV. Although various treatments for these symptoms, such as tadalafil and testosterone replacement therapy, were administered, the symptoms did not improve. Here, we report a case of EjD associated with SV and prostate abscesses. Factors leading to SV atrophy are unknown; however, complications should be noted.

Transperineal Drainage of Seminal Vesicle Abscess Under Local Anaesthetic: A Case Report

A 44-year-old healthy Caucasian gentleman presented with fevers and right lower quadrant pain. He had mildly elevated inflammatory markers and computed tomography demonstrated cystic enlargement of the right seminal vesicle concerning for seminal vesicle abscess (SVA). SVA is a rare diagnosis and generally requires drainage for adequate source control. The patient was commenced on intravenous antibiotics and underwent uncomplicated transperineal drainage of seminal vesicle abscess under local anaesthetic. Urine culture confirmed infection with Citrobacter koseri and the patient was discharged on the first post-operative day with a 14-day course of oral co-trimoxazole. Six-week follow-up with multiparametric magnetic resonance imaging of the prostate shows no evidence of any prostatic lesions, prostatitis or recurrence of abscess.

Viruses, bacteria and parasites: infection of the male genital tract and fertility

BACKGROUND

Infertility affects one couple out of six worldwide. Male infertilty can result from congenital or acquired factors, of which pathogens that reach the genital tract through sexual contact or blood dissemination. The impact of major viral, bacterial and parasitic infections on the male genital tract and fertility has been summarized.

RESULTS AND CONCLUSIONS

A systematic review of articles published in the Google Scholar and PubMed databases was conducted. It turns out that viruses, as well as bacteria and parasites are major inducers of male genital tract infections and ensuing infertility through damage to the organs and subsequent loss of function and/or through direct damage to the sperm cells. Moreover, not only male infertility results from such infections but these can also be transmitted to women and even to the offspring, thus highlighting the need to efficiently detect, treat and prevent them.

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.

Acute Epididymo-Orchitis Complicated With Abscesses in Testis and Seminal Vesicles: A Case Report

Epididymo-orchitis is a common intra-scrotal inflammation among males that causes swelling of the epididymis and testis. In the era of modern antibiotics, complications associated with this condition are now rare. Herein, we report a 28-year-old man with acute epididymo-orchitis complicated by the formation of several abscesses involving the left testis and seminal vesicles. The literature review showed this patient as the first case with such extensive complications following epididymo-orchitis. Initial antimicrobial therapy was unable to resolve the condition. The management necessitated surgical intervention, which included MRI-guided aspiration of the seminal vesicle abscesses and testicular sparing drainage of the testicular abscess.

Safety and Efficiency of Prostatic Abscess Transgluteal Drainage: A Case Report and Review of the Literature

Prostatic abscess (PA) is an uncommon disorder that mainly affects diabetic and immunocompromised patients. It requires a high index of suspicion for diagnosis since it can clinically mimic acute prostatitis. Historically, transurethral drainage along with antimicrobial therapy has been the gold standard therapy. However, advances in imaging modalities have shifted the management of PA to less invasive approaches. Here, we present a case of a large PA drained by the percutaneous transgluteal approach. This access route is a safe, effective, and well tolerated alternative for PA drainage, done under local anesthesia and providing a relatively cleaner approach than transrectal or transperineal drainage, allowing easier and better catheter fixation as well. This article illustrates the different steps of the procedure and reviews the literature on PA management.

Seminal vesicle abscess: A case report and review of the literature

Seminal vesicle abscess (SVA) is a rare pathology. We review the literature and present the case of a 54-year-old presenting with an SVA treated successfully with percutaneous transgluteal drainage and subsequently, transrectal ultrasound (TRUS)-guided transrectal drainage.

Level of evidence: 4

Imaging spectrum of common and rare infections affecting the lower genitourinary tract

In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.

Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs

Complicated urinary tract infections (C-UTIs) are those associated with structural or functional genitourinary abnormalities or with conditions that impair the host defence mechanisms, leading to an increased risk of acquiring infection or failing therapy. C-UTIs occur in patients with risk factors such as neurogenic dysfunction, bladder outlet obstruction, obstructive uropathy, bladder catheterisation, urologic instrumentation or indwelling stent, urinary tract post-surgical modifications, chemotherapy- or radiation-induced damage, renal impairment, diabetes and immunodeficiency.

Multidetector CT and MRI allow comprehensive investigation of C-UTIs and systemic infection from an unknown source. Based upon personal experience at a tertiary care hospital focused on the treatment of infectious illnesses, this pictorial essay reviews with examples the clinical features and cross-sectional imaging findings of C-UTIs affecting the lower urinary tract and male genital organs. The disorders presented include acute infectious cystitis, bladder mural abscesses, infections of the prostate and seminal vesicles, acute urethritis and related perineal abscesses, funiculitis, epididymo-orchitis and scrotal abscesses. Emphasis is placed on the possible differential diagnoses of lower C-UTIs.

The aim is to provide radiologists greater familiarity with these potentially severe disorders which frequently require intensive in-hospital antibiotic therapy, percutaneous drainage or surgery.

Teaching Points

• Complicated urinary tract infections occur in patients with structural or functional risk factors.

• CT and MRI comprehensively investigate complicated urinary infections and sepsis from unknown sources.

• Infections of the urinary bladder, prostate, seminal vesicles, urethra and scrotum are presented.

• Emphasis is placed on differential diagnoses of complicated lower urogenital infections.

• Unsuspected urinary infections may be detected on CT performed for other clinical reasons.

An unusual groin mass. Seminal vesicle abscess: a case report

The rare pathology of seminal vesicle abscess is usually diagnosed with computerised tomography scan and confirmed with transrectal ultrasound. We report a recently encountered case where diagnosis proved difficult owing to the non-specific clinical presentation.

Seminal vesicle abscesses associated with ipsilateral multicystic dysplastic kidney in an infant

Seminal vesicle cysts are rare lesions and usually asymptomatic. However, when symptoms occur it is typically during the early sexually active period. Furthermore, seminal vesicle abscesses (SVAs) are extremely rare and often difficult to diagnose due to the absence of any typical clinical signs. We herein describe a 2-month-old boy with a left SVA and ipsilateral multicystic dysplastic kidney (MCDK) who presented with a recurrent urinary tract infection (UTI). Magnetic resonance imaging proved to be a valuable diagnostic tool in our patient. Percutaneous transrectal puncture and aspiration were performed, because of recurrent UTI when intravenous antibiotic therapy had been stopped. Three weeks after the procedure, however, the SVA recurred, and, therefore, a transperitoneal laparoscopic excision of the left SVA, ureteral remnant and dysplastic renal tissue was performed. To the best of our knowledge, this is the first case of infantile SVA associated with ipsilateral MCDK. Pediatric clinicians should consider this urological anomaly in boys presenting with intractable UTI, although it is extremely rare.

Seminal vesicle cyst forming an abscess and fistula with the rectum review of perianal drainage and treatment

The clinical presentation and treatment modalities of seminal vesical abscesses are not well documented. The first case of a seminal vesicle cyst which formed an abscess after transrectal aspiration with subsequent formation of a fistula with the rectum is reported herein. The abscess was drained perianally, an approach that has not previously been reported. A brief comparison of the reported treatment modalities is also provided.

Use of transperineal fine needle aspiration of seminal vesicles to retrieve sperm in a man with obstructive azoospermia

OBJECTIVE

To report the successful and feasible use of transperineal fine needle aspiration of seminal vesicles (FNASV) for sperm retrieval in obstructive azoospermia.

DESIGN

Case report.

SETTING

Outpatient care in institutional clinic.

PATIENT(S)

A 31-year-old man with obstructive azoospermia due to a middle prostatic müllerian cyst.

INTERVENTION(S)

Transperineal FNASV using a coaxial 17-gauge TruGuide needle.

MAIN OUTCOME MEASURE(S)

Feasibility of sperm retrieval suitable for future in vitro fertilization.

RESULT(S)

Transperineal FNASV made it possible to aspirate 11 mL of fluid with a sperm count of 100 million/mL and 15% motility. This sample was cryopreserved for in vitro fertilization using intracytoplasmic sperm injection.

CONCLUSION(S)

Transperineal FNASV using a coaxial needle may be a further method for sperm retrieval to add to the repertoire of assisted reproduction technologies.