RESUMO
Ejaculatory duct obstruction is a rare condition identified in up to 5% of infertile men. Patients with ejaculatory duct obstruction can present with aspermia, azoospermia or oligoasthenospermia, painful ejaculation, hematospermia, prostatic pain, or male infertility. Semen analysis, transrectal ultrasonography, pelvic computerized tomography and magnetic resonance imaging are often used in the diagnostic work up, but with limited accuracy. While transurethral resection of the ejaculatory ducts has good efficacy for distal duct obstruction, results for proximal obstruction are less impressive, and it might cause severe complications, such as rectal injury and urinary incontinence. Recently, the use of high quality endourological devices and an improved understanding of ejaculatory ducts anatomy gleaned through the use of sophisticated imaging tools have led to the development of novel minimally invasive treatment options for this condition. The present study aims to report an index case of ejaculatory ducts obstruction managed with seminal vesiculoscopy, and review the current literature regarding this topic.
RESUMO
RESUMEN La patología tumoral de las vesículas seminales es extremadamente poco frecuente. Sólo existen reportes de series de casos que no logran ser más de 150 en todo el mundo. Por lo mismo, no existen pautas de recomendación para el diagnóstico y tratamiento. A propósito de 2 casos de tumores de vesículas seminales ocurridos en un período de 12 meses en nuestro centro, hemos decidido realizar una revisión de la literatura actual sobre el estudio y manejo de esta patología poco frecuente. La sintomatología es inespecífica, y su diagnóstico comprende una combinación de test sanguíneos, imagenológicos e histopatológicos en su mayoría para descartar otras neoplasias. El tratamiento es multimodal el cual incluye resección quirúrgica donde la vía laparoscópica es el patrón de oro, asociado a adyuvancia con hormonoterapia y/o radioterapia. Su pronóstico es pobre debido al diagnóstico en etapas avanzadas, por lo que se requiere un alto índice de sospecha diagnóstica para lograr realizar un tratamiento oportuno.(AU)
Abstract The tumor pathology of the seminal vesicles is extremely rare. There are only reports of series of cases that fail to be more than 150 worldwide. For this reason, there are no recommendation guidelines for diagnosis and treatment. With regard to 2 cases of seminal vesicle tumors that occurred in a period of 12 months in our center, we decided to review the current literature on the study and management of this rare pathology. The symptomatology is non-specific, and its diagnosis includes a combination of blood, imaging and histopathological tests, mostly to rule out other neoplasms. The treatment is multimodal, which includes surgical resection where the laparoscopic approach is the gold standard, associated with adjuvance with hormone therapy and / or radiotherapy. Its prognosis is poor due to the diagnosis in advanced stages, which is why a high index of diagnostic suspicion is required to achieve an opportune treatment.(AU)