Scandinavian Journal of Urology and Nephrology

ISSN: 0036-5599 (Print) 1651-2065 (Online) Journal homepage: http://www.tandfonline.com/loi/isju19

Cyst of Seminal Vesicle Associated with Ipsilateral Renal Agenesis P. Øgreid & K. Hatteland To cite this article: P. Øgreid & K. Hatteland (1979) Cyst of Seminal Vesicle Associated with Ipsilateral Renal Agenesis, Scandinavian Journal of Urology and Nephrology, 13:1, 113-116, DOI: 10.3109/00365597909180010 To link to this article: http://dx.doi.org/10.3109/00365597909180010

Published online: 15 Feb 2010.

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Date: 19 April 2016, At: 10:25

Scand J Urol Nephrol 13: 113-1 16, 1979

CYST OF SEMINAL VESICLE ASSOCIATED WITH IPSILATERAL RENAL AGENESIS

P. ggreid and K. Hatteland From t h t Urolo,yictrl S r c ~ t i o t ~Thr. . Cetirrtrl Hmpirtrl of’Rogtrlnnii. Sttr\wngc~r.Noritwy

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(Submitted for publication November 27. 1977)

AbArmct. Four cases of seminal vesicle cyst associated with agenesis of the ipsilateral kidney are presented. The literature and the embryologic development of this rare anomaly are briefly surveyed.

Cysts of the seminal vesicle without associated urogenital malformations were described by Guiteras (1894) and by Damski (1908). The combination of seminal vesicle cyst and agenesis of the ipsilateral kidney was first reported by Zinner in 1914. The literature up to 1969 contained reports on 13 cases of seminal vesicle cyst. only four of which were associated with ipsilateral renal agenesis. This combined anomaly appears to be relatively unknown (Holt & Peterson, 1974; Reddy & Winter, 1972). In 1976 Fuselier J r & Peters presented a case of this type, which they found to be the twentieth in the literature. The largest collection in a single paper seems to be the seven cases described by Donohue & Greenslade (1973). The present report concerns four cases of seminal vesicle cyst combined with ipsilateral renal agenesis. All four patients were from Rogaland County in Norway, an area of about 9000 km’ with a population of approximately 300000 (Fig. I ) . About two-thirds of this population live in the catchment area of our hospital. That four cases of the combined anomaly should occur in such a small population seems remarkable.

CASE REPORTS Case I . A 57-year-old dairyman. married. with two children, had a history of duodenal ulcer in 1960. In 1967 he was admitted to Rogaland Hospital because of attacks of pain in the lower dorsal region and in the hips. right groin, scrotum and rectum. He had frequent micturition but no haematuria. Rectal palpation revealed an oblong, 8-792912

thumb-thick tumour proximal to and on the right of the prostate gland. Analyses of blood and urine gave normal findings. An excretory urogram showed aplasia of the right kidney, which was confirmed by tomography. Cystoscopy showed no right renal orifice and a normal left orifice. At operation a blood-containing tumour originating from and including the right seminal vesicle was removed. It measured approximately 3.5X10 cm. The histologic report stated cyst of the right seminal vesicle with chronic infection and old bleeding. No renal tissue was seen in the specimen. Case 2. A 22-year-old welder, married and with a oneyear-old child. had for some weeks towards the end of 1967 and in May and November 1968 complained of dysuria. frequency of micturition and dyspareunia. As he also had anal pain. he attributed his symptoms to haemorrhoids. After rectal exploration and cystoscopy he was referred to this hospital with a tentative diagnosis of cyst of the right seminal vesicle. At rectal examination a soft, orange-sized tumour was felt to the right in the rectal ampulla. Urine and blood analyses were negative. An excretory urography revealed no kidney on the right side. Cystoscopy showed no right ureteral ostium and there was a tumour impression beneath the trigone. A cyst of the right seminal vesicle, 8 to 10 cm in diameter and containing brown fluid, was extirpated together with the ductus deferens. Microscopy confirmed the diagnosis of simple cyst of the seminal vesicle. Case 3. A 26-year-old unmarried farmer had a threeyear history of periodic slight symptoms of urethritis and haemospermia with scrota1 pain. He denied any sexual contact and there were no signs of venereal disease. Rectal exploration by his own doctor had shown a mass about 4 x 4 cm situated on the right and proximal to the prostate gland. Seminal vesicle cyst was the clinical diagnosis. On admission to Rogaland Hospital in November 1969 the same indolent cystic swelling was felt. Laboratory tests, including urinalysis, showed nothing abnormal. At urography there was a hypertrophic, solitary left kidney. Absence of the right kidney was confirmed by tomography. Cystoscopy showed no right ureteral orifice and there was an impression beneath the right part of the trigone in the bladder. The seminal vesice cyst was surgically removed. At operation the ducturs deferens was identified as normal. An ectopic ureter and an atrophic Scrind J iJro/ Nc’pirrol 13

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I14

P.ggreid

rind K . Hritreltiircr'

Fig. I . Survey of Norway, including Rogaland County with the city of Stavanger.

kidney were suspected to be present on the right side (Fig. 2), but the pathologist could not confirm the presence of renal or ureteral tissue. Case 4 . A 56-year-old farmer, married but with no children, gave a history of lumbago in 1971. In February 1972 he noticed blood in the urine and was immediately

admitted to Rogaland Hospital. The physical findings were normal except in rectal exploration, which revealed a cystic tumour 5-6 cm in diameter, situated proximal to and on the right ofthe prostate. Blood tests were negative. Microscopy of the urine showed leukocytes and erythrocytes. At excretory urography the left kidney was enlarged and there were no signs of a right kidney. Cystography was normal apart from a small diverticulum on the right side. At cystoscopy a small papilloma of the bladder was seen near the left ostium. The right urethral orifice was lacking, but the trigone was normal. The papilloma was transurethrally resected a few days later. In March 1972 a cyst of the right seminal vesicle was removed (Fig. 3). The diagnosis was histologically confirmed. N o ectopic kidney or ureter was seen on the right side. The patient has been re-examined annually. There has been no recurrence of the bladder tumour and rectal exploration has shown nothing abnormal.

DISCUSSION

Fig. 2. Cystically enlarged seminal vesical (left) and suspected ectopic ureter and kidney (right). Case 3. Scrim/ .I Urol Nrphrol I3

The embryologic development of the male urogenital system, including the seminal vesicles, was described in detail by Holt & Peterson and by Koyanagi, Tsuji, Kudo, Ischikawa & Sasaki (1972).

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C '75rnm fefu;

f u / / ferm

Pigone ~ a c u f u f o r yducf (Mesonephric ducf)

Fig. 3 . Intact surgical specimen. Excised seminal vesicle with cystic, irregular apperance. Case 4 .

Fig. 4 . Development of the ureter from the mesonephric duct, which also gives rise to the ejaculatory duct. The segment of the mesonephric duct that is incorporated in the urogenital sinus expands to form the trigonal tissue (Tanagho & Hutch, 1965).

Tanagho Lk Hutch (1965) and other writers. When the fetus is five to six weeks old the cloaca divides into a dorsal segment and a ventral or urogenital segment (Harbitz & LiavBg, 1968). The mesonephric duct empties into this urogenital segment and gives off a ureteric bud (Fig. 4). From the remaining mesonephric duct the seminal vesicle, ejaculatory duct, vas deferens. posterior urethra and part of the epididymis arise. The seminal vesicle separates from the mesonephric duct around the 13th week of intra-uterine life (Davidson & Beard, 1969). If the ureteric bud and the rnetanephrogenic mass fail to fuse, the kidney will not form. Other reasons for renal agenesis may be failure of the ureteric bud to develop, failure of the nephrogenic blastoma to form, or failure of the vascular supply. A prerequisite for differentiation of the metanephrogenic mass to form a kidney is that the primordial ureteric diverticulum grows into it (Meiraz, Fischelovitch & Lazebnik, 1973). Accordingly, a kidney never forms in the absence of the ureter (Koyanagi et al.). Changes in this complex

differential pattern may result in an abnormal communication between the two systems, leading to various urogenital malformations. None of our four patients had specific symptoms leading to the diagnosis. Dysuria, pain in the perineal region and dorsalgia are nonspecific and may occur also from prostatitis. The diagnosis in these cases was made by digital exploration of the rectum and was confirmed by excretory urography, cysto-urethroscopy and finally operation. Walls & Lin (1975) reported a case in which seminal vesicle cyst was diagnosed by ultrasound €3-scan only. Transperineal or transrectal aspiration of the cyst may be both diagnostic and therapeutic (Beeby, 1974). The presence of spermatozoa in the aspirate from a cyst will yield the diagnosis. For ascertaining agenesis of the ipsilateral kidney, angiography, isotope renography , ultrasonic examination and computer tomography are valuable. We did not use vesiculography, since it tends to cause occlusion of the ductus deferens. The differential diagnosis of cystic tumours in the minor pelvis in males should Sccind J Urol Nephrol 13

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include cvsts of the Mullerian o r Wolffian duct remnant, cyst of the utricle, leiomyoma of the bladder wall with degenerative changes, malignant rectal lesions that involve the bladder and walled-off abscess in the cul-de-sac from a leaking diverticulum of the colon (Fuselier Jr & Peters). The treatment will depend on the severity of the symptoms. Hart (1966)treated his two patients conservatively, whereas Reddy & Winter performed transurethral electroresection. In our four patients the cysts were surgically removed in order to confirm the diagnosis, but also because of the symptoms. The malformations in the four cases here reported were all on the right side. This may be accidental, since the literature shows approximately equal distribution between the right and the left side (Fuselier Jr & Peters).

REFERENCES Beeby, D. I. 1974. Seminal vesicle cyst associated with ipsilateral renal agenesis. Case report and review of the 1iterature.J Urol 112. 120. Damski, A. 1908. Cas d'un kyste des vesicules seminales. Ann Ma/ Org Gen-urin 26. 981. Davidson, A. C . & Beard, J . H . 1969. A seminal vesicle cyst in association with ipsilateral renal agenesis and lumbar scoliosis. Southern Med J 62. 608.

Scrind J Urol Nrplirol 13

Donohue. R. E. & Greenslade. N . E. 1973. Seminal vesicle cyst and ipsilateral renal agenesis. Uro/o,q.~ 2. 66. Fuselier Jr.. H . A. & Peters. D. H. 1976. Cyst of the seminal vesicle with ipsilateral renal agenesis and ectopic ureter. Case report../ Uro/ 116, 833. Guiteras, R . 1894. A case of seropumlent cyst. probably of the right seminal vesicle. L n m e r 11. 74. Harhitz, T. B. & Liavig. I. 1968. Urogenital malformation with cyst of the seminal vesicle, ipsilateral dilated ureter and renal agenesis. Report of a case and review of the literature. SccrndJ Urol Nephrol?. 217. Hart, J . B. 1966. A case of cyst of the seminal vesicle. J Urol 96. 247. Holt. S. A. & Peterson, N. E . 1974. Ectopia of seminal vesicle associated with agenesis of ipsilateral kidney. Urology I V , 322. Koyanagi. T., Tsuji, I., Kudo, T.. Ischikawa. T. & Sasaki, K . 1972. Double vas deferens associated with ipsilateral renal agenesis. simulating ectopic ureter. J Urol 108. 63 1 . Meiraz, D., Fischelovitz. J . & Lazebnik. J. 1973. Agenesis of the kidney associated with congenital malformation of the seminal vesicle. Br J Urol45.541. Reddy, Y . N . &Winter, C. C. 1972. Cyst of the seminal vesicle: A case report and review of the literature. J Urol 108, 134. Shama. F. C . , Dorman, P. S . & Dorman. H. P. 1969. Bilateral seminal vesicular cyst. J Urol 102. 741. Tanagho, E . A. & Hutch. J . A. 1965. Primary reflux. J Urol 93, 158. Zinner, A. 1914. Ein Fall von intravesikaler Samenblasenzyste. Wien Med Wschr 64. 606. Walls, W. J . & Lin, F. 1975. Ultrasonic diagnosis of seminal vesicle cyst. Radiology 114, 693.

Cyst of seminal vesicle associated with ipsilateral renal agenesis. A report on four cases.

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