What's your diagnosis

• 04 Jun 2021 06:55:26 PM
• |Endo Urology

30 years male...

Comments(5)

• 

  Dr. Anil Takvani

  05 Jun 2021 08:47:17 PM

  This male patient had painful and scanty ejaculation of semen since couple of months.

  This is a usg picture of pelvis for prostate and seminal vehicles with full bladder. 

  Please give your diagnosis...thanks 

• 

  Dr. Anil Takvani

  09 Jun 2021 06:30:01 PM

  Posting sonologist report. 

  Discuss diagnosis and treatment. 

  Thanks.

  

• 

  Venugopal P

  12 Jun 2021 10:35:23 AM

  Dear All,

  Anil has posted a case with History of Painful and Scanty Ejaculation of Semen in a 30 yrs old male. His US has been reported as his having a midline cyst in the prostate of approximately 2.5 Cms.

  I am providing Links for two articles published in radiology Journals addressing Prostatic Cysts. One is on detection of Prostatic cysts with Transabdominal US (as has been done in Anil’s case)

  https://www.ajronline.org/doi/pdfplus/10.2214/ajr.181.6.1811669

  The other one is on ‘Cysts of the Lower Male Genitourinary Tract’ wherein Embryological and Anatomical Considerations have been described.

  https://pubs.rsna.org/doi/pdf/10.1148/rg.334125129

  Prostatic cysts are mostly asymptomatic. Only 5% prostatic cysts are symptomatic. Associated symptoms include pelvic pain, haematospermia, infertility, voiding dysfunction, prostatitis-like syndrome, and painful ejaculation.  

  Midline cysts, located posteriorly at the prostatic floor, are mostly of developmental origin and arise from remnants of foetal tissue—in the utricle or Mullerian duct. Whereas Mullerian cysts are mesodermal in origin, contain spermatozoa, and are located more posteriorly nearer to the prostate base, (the case Anil has posted probably belongs to this type as it shows internal Echoes suggestive of presence of sperms). Utricular cysts are mostly endodermal, contain no spermatozoa, and are located near the verumontanum.

  Transurethral deroofing of the prostatic cyst to sub-fertile men with one or more of the following semen abnormalities: decreased seminal volume, decreased motility, Oligozoospermia or azoospermia, in order to improve semen quantity and quality and pregnancy rate. Prior to deroofing, it would be advisable to measure the distance between the cyst and the Urethra. TRUS Guidance could be help.

  Deroofing could be done using Colling’s Knife Electrocautery or of late as performed by Mehmet Kilinc, Yunus Emre Goger* (2015) using Holmium laser.

  Deroofing the cyst has resulted in considerable success to alleviate the symptoms of the patient

  With warm Regards,

  Venu

   

• 

  Dr. Anil Takvani

  12 Jun 2021 11:51:05 AM

  Thank you very much sir.

  Trans urethral deroofing was done with Colling's knife as described by Prof.Venugopal.

  His symptoms disappeared.

  Post procedure two months USG is reported normal,

  Small piece of tissue was removed for histopathology.

  Will post report soon.

  
  

  Thanks.

  
  

• 

  Dr. Anil Takvani

  12 Jun 2021 11:56:06 AM

  Histopathology report attached 

  Thanks