Lethal infected seminal vesicle cyst

Abstract

A 56-year-old healthy male complained of fever, dysuria and urinary retention. Past medical history was unremarkable. An abdominal computed tomography scan showed a mass in the right pelvic cavity near the bladder and right renal agenesis (Figure 1, Figure 2). An infected right seminal vesicle cyst was diagnosed.Figure 2The lesion is extended from the enlarged right seminal vesicle cyst.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Septicemia persisted even though urethral catheterization was indwelled and strong antimicrobial therapy was administered. Blood culture yielded two pathogens: Escherichia coli and Klebsiella pneumoniae. Attempted ureteroscopy and cystoscopy revealed a right ureteral orifice that could not be identified. We performed transrectal ultrasound-guided drainage, which aspirated dark fluid with blood clots. The aspirated fluid culture grew the same two microorganisms. The patient died of progressive sepsis on the tenth day of admission. Seminal vesicle cysts are rare entities; two-thirds are associated with renal dysplasia or agenesis, and ectopic ureter. Seminal vesicle cysts are usually diagnosed in adulthood. The mechanism of cyst formation is thought to involve the build up of seminal vesicle fluid due to an abnormal or obliterated ejaculatory duct.1van den Ouden D. Blom J.H. Bangma C. de Spiegeleer A.H. Diagnosis and management of seminal vesicle cysts associated with ipsilateral renal agenesis: a pooled analysis of 52 cases.Eur Urol. 1998; 33: 433-440Crossref PubMed Scopus (127) Google Scholar Presenting symptoms include urgency and frequency of urination, dysuria, perineal or suprapubic pain, painful ejaculation and post-coital discomfort.1van den Ouden D. Blom J.H. Bangma C. de Spiegeleer A.H. Diagnosis and management of seminal vesicle cysts associated with ipsilateral renal agenesis: a pooled analysis of 52 cases.Eur Urol. 1998; 33: 433-440Crossref PubMed Scopus (127) Google Scholar To our knowledge, this is the first lethal case of an infected seminal vesicle cyst. In the literature, transrectal aspiration was shown to temporarily relieve symptoms and control the infection2Cherullo E.E. Meraney A.M. Bernstein L.H. Einstein D.M. Thomas A.J. Gill I.S. Laparoscopic management of congenital seminal vesicle cysts associated with ipsilateral renal agenesis.J Urol. 2002; 167: 1263-1267Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar; however, the procedure failed to reverse the progressive infectious process in our patient. Laparoscopy and robot-assisted removal of the seminal vesicle cyst, dysplastic kidney and ureter have been reported as a feasible operation for this disease state.2Cherullo E.E. Meraney A.M. Bernstein L.H. Einstein D.M. Thomas A.J. Gill I.S. Laparoscopic management of congenital seminal vesicle cysts associated with ipsilateral renal agenesis.J Urol. 2002; 167: 1263-1267Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar, 3Selli C. Cavalleri S. De Maria M. Iafrate M. Giannarini G. Robot-assisted removal of a large seminal vesicle cyst with ipsilateral renal agenesis associated with an ectopic ureter and a Müllerian cyst of the vas deferens.Urology. 2008; 71 (e5-7): 1226Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Laparoscopic en bloc excision might be the only way to rescue patients with a seminal vesicle cyst and severe infection. No conflict of interest to declare.