Seminal Vesicle Cyst
with Reflux
with Reflux
The seminal vesicles are paired structures posterior to the bladder which fuse distally to form the ejaculatory duct. During ejaculation, the secretions optimize conditions for sperm motility, transport and survival. Along with the urinary system, seminal vesicles are derived from the mesonephric duct. Although rare, anomalies of the seminal vesicles include number (agenesis and fusion), maturation (hypoplasia) and canalization (cysts). Seminal vesicle cysts can be congenital or acquired. Congenital cysts are secondary to obstruction of the ejaculatory duct secondary to maldevelopment of the distal portion of the mesonephric duct. Cysts are almost always solitary. They are often associated with ipsilateral urinary anomalies to include ectopic insertion of the ureter (second most common site after the prostatic urethra) and renal agenesis, hypoplasia, dysplasia and duplication. Cysts may be seen with normal kidneys and ureters. Other associations include polycystic kidney disease, hemivertebra, infertility, and absence or atresia of the vas deferens and testicle. Acquired cysts are associated with inflammation and obstruction of the ejaculatory ducts and seminal vesicles secondary to urinary infection and calculi.
Small cysts are asymptomatic. Symptomatic cysts present typically during the period of maximum sexual and reproductive activity. Symptoms are predominately perineal pain, but may be localized to the abdominal, flank, pelvis or scrotum. Pain may be exacerbated during ejaculation or defecation. Urinary frequency, dysuria, urgency, bladder outlet obstruction and ureteric obstruction may occur. Recurrent infection, abscess, epididymitis and chronic prostatitis are also reported. Large cysts may be palpable on abdominal exam, while smaller cysts are palpable rectally.
Ultrasonography is the study of choice. Seminal vesicle cysts typically appear as paramedian retrovesical cystic masses. Mullerian duct cysts are midline with normal seminal vesicles. Needle aspiration demonstrates the presence of spermatozoa, differentiating seminal vesical cysts from other cystic masses. Upper tract imaging is essential in all cases. Ipsilateral renal anomalies as those described above should be sought. Voiding cystourethrography and seminal vesiculography can help detect connections between the seminal tract and urinary tract. 
Differential Diagnosis
1. Wolffian or Mullerian duct cyst. 2. Prostatic cyst. 3. Benign and malignant tumors. 4. Diverticula of the ejaculatory ducts.
Treatment
Treatment is necessary in only symptomatic cysts. Options include transurethral resection and drainage into the bladder, to laparoscopic or open exploration and excision. Combined excision of an ipsilateral dysplastic kidney may be performed in conjunction with cyst removal.
References
1. Patel B. et al., Review; Seminal Vesicle Cysts and Associated Anomalies. 2002 BJU International 90, pp 265-271
2. King BF et al. Congenital Cystic Disease of the Seminal Vesicle. Radiology 1991; 178:207-211
A. Left ureteric reflux
B. Reflux into seminal vesicle cyst
C. Verumontanum
D. Membranous urethra
B
C
D
A
B
C
A. Transverse ultrasound of the bladder demonstrating “cysts” posterior to the bladder.
B. Longitudinal ultrasound demonstrating the dilated right serpentine seminal vesicle
D. Sagittal T2 Image of the bladder and dilated seminal vesicle
C. Ultrasound demonstrating the empty right renal fossa
A
