Intraoperative transrectal ultrasonography in the management of ejaculatory duct obstruction caused by midline prostatic cyst

Abstract

The differential diagnosis of cystic lesions of the prostate includes miillerian duct cysts, utricle cysts, cysts of the seminal vesicles or ejaculatory ducts, prostatic retention cysts, and prostatic abscesses. These are usually discovered incidently during transrectal ultrasound examination of the prostate, but are occasionally detected during the investigation of lower urinary tract symptoms or infertility. We report a case of ejaculatory duct obstruction secondary to a midline cyst of the prostate, and describe the intraoperative use of transrectal ultrasonography in guiding transurethral resection. CASE REPORTA 39-year-old man with a complaint of decreased ejaculate volume was referred to our institution after transurethral resection failed to relieve what was thought to be an ejaculatory duct obstruction. The patient recalled that, since his early 20s, he had had a substantial decrease in his ejaculate volume. He initially did not seek medical attention. Several years later, after a single episode of hemospermia, he sought medical advice; however, no specific investigations or treatments were performed. He presented at this time for definitive evaluation.An initial semen evaluation revealed an ejaculate volume of 0.1 mL, which was negative for sperm and fructose. Serum follicle stimulating hormone (FSH) was 9 mIU/mL (normal 2 mIU/mL to 15 mIU/ml). A testicular biopsy, performed at the same time as the transurethral re-

Vaginal stenosis treatment using computed tomography and fluoroscopy guidance

“…Male genitourinary tract dilatation under image guidance has been reported, 9 particularly using ultrasound via a transrectal or transurethral route. 10 , 11 , 12 , 13 In terms of female genitourinary tract reconstruction, combined surgical and radiologic techniques have also been applied to create a neoendocervical canal in the setting of congenital vaginal atresia. 14 However, most literature for vaginal recanalization procedures focuses on congenital anatomic defects in vaginal canal patency, whereas our case is unique in presenting with acquired postoperative vaginal stenosis.…”