The seminal vesicles represent paired male organs (no female homologue) which develop from the distal mesonephric duct, just proximal to the ejaculatory duct. The major canal of the seminal vesicle empties into the ejaculatory duct at the terminal portion of the vas deferens within the prostate. As with any ductal structure in the human body, the distal opening of a duct may become stenotic, resulting in obstruction, or patulous, resulting in reflux. Causes associated with reflux not only into the seminal vesicles but also the prostate and vas deferentia, include urethral obstruction (stricture, stones, anterior and posterior urethral valves), voiding dysfunction and functional disturbances of the bladder neck, inflammatory disease, surgery, urethral manipulation and in otherwise normal individuals.

 

Reflux of contrast into the ejaculatory ducts is seen on excretory urography and/or retrograde urethrogram, and can represent normal variation or occur in association with other urinary tract abnormalities, in particular distal obstructions or more commonly long term intermittent catheterization. Though infrequent, ejaculatory duct reflux is most commonly identified as an incidental finding, though an appropriate clinical history and radiographic investigation of urinary tract infection and/or epididymitis in a young, prepubertal boy may yield presence of this entity.

 

Reflux into the prostatic ducts is also commonly seen in the same instances and may be benign or in older patients associated with an increased incidence of prostatitis.

 

 

The presentation includes pain, fever, recurrent epididymitis-prostatitis, post-void dribbling.

 

Images from voiding cystourethrogram above demonstrate contrast refluxing into the right seminal vesicle. Patient has a history of chordee repair and distal urethral stricture.

 

The treatment reflects the underlying condition.

 

 

References

 

1. Mitty, Harold. Roentgen Features of Reflux into the Prostate, Seminal Vesicles and Vas Deferentia. AJR Vol.112, No. 3. July 1971.

 

2. Fisch, Harry et al. Ejaculatory Duct Obstruction. Curr Curr Opin Urol 12:509-515. 2002 Lippincott Williams & Wilkins.