Seminal vesicle cyst presenting as rectal obstruction

We report an unusual case of a pelvic mass arising from the seminal vesicle. A 45-year-old man presented with difficulty voiding and difficult bowel movements. Computed tomography demonstrated a large 14 x 10 x 15-cm cystic pelvic mass displacing the bladder anteriorly and the rectum posteriorly. Magnetic resonance imaging confirmed that this lesion appeared to be originating from the right seminal vesicle. On surgical exploration of the abdomen, a large cystic lesion in the posterior retroperitoneum was identified and removed. The patient improved, with restoration of normal bowel function.

Congenital seminal vesicle cyst and coexisting renal agenesis: laparoscopic approach

We report a case of laparoscopic excision of a large symptomatic left seminal vesicle cyst and ipsilateral renal agenesis. A 26-year-old man presented with a 15-year history of dysuria and irritative voiding symptoms. The diagnostic evaluation revealed a 62 x 40 x 35-mm left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with no evidence of the left renal unit. Transperitoneal laparoscopic excision of the cyst was performed successfully. The total operative time was 190 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day and did not present with any complaints or complications thereafter.

Invasion of seminal vesicles by adenocarcinoma of the prostate: PSA outcome determined by preoperative and postoperative factors

OBJECTIVES

To determine which preoperative and postoperative factors were predictive of the time to prostate-specific antigen (PSA) failure after radical retropubic prostatectomy (RRP) for patients with seminal vesicle invasion (SVI). SVI by prostate cancer is associated with high PSA failure rates after RRP and subsequent distant metastases.

METHODS

Between 1988 and 2002, 1697 patients with prostate cancer underwent RRP at Brigham and Women's Hospital, of whom 103 (6%) had SVI. Cox regression multivariable analysis was used to determine whether the preoperative PSA level, prostatectomy Gleason score, margin status, or presence of extraprostatic extension was predictive of the time to postoperative PSA failure. Estimates of PSA outcome were made using the actuarial method of Kaplan and Meier for patients who had none, all, or at least one of the factors that predicted for the time to postoperative PSA failure.

RESULTS

The statistically significant categorical predictors of the time to PSA failure after RRP in patients with SVI included prostatectomy Gleason score of 4+3 or greater (P = 0.009), preoperative PSA level greater than 20 ng/dL when evaluated as a categorical or as a continuous variable (P = 0.002 and P = 0.001, respectively), and margin positivity (P = 0.075) which was of borderline significance. The 3-year estimate of PSA control was 52% to 100%, 28%, and 0% for patients with negative margins, preoperative PSA less than 20 ng/dL, and prostatectomy Gleason score of 3+4 or less versus having one to two or all three predictors of the time to postoperative PSA failure.

CONCLUSIONS

The PSA outcome after RRP for patients with SVI varies depending on the preoperative PSA level, prostatectomy Gleason score, and margin status.

Leiomyoma of the seminal vesicles

We report the case of a 37-year-old man suffering from dysuria, frequency, acute renal failure followed by bowel distress with rectal tenesmus. PSA was 6.19 ng/ml. CT of abdomen and pelvis revealed a probable prostatic-related pelvis mass. TRUS was not carried out due to intolerance. The patient underwent laparotomy through a lower midline incision that confirmed a firm, even if not involving the adjacent organs, considerable pelvic mass adhering to the left seminal vesicle and involving the right one. Therefore the right seminal vesicle and the mass originating from it were removed. Three months follow-up showed a clinically recovered patient, free of voiding and intestinal symptoms, back to normal working activity.

Large solitary fibrous tumor of the seminal vesicle

Solitary fibrous tumors show a classic morphologic pattern ("patternless pattern") consisting mainly of a proliferation of bland spindle cells with varying amounts of thick, often hyalinized or keloid-like, intercellular collagen bundles. Immunohistochemistry shows a strong reactivity for CD34 antigen, vimentin, and, in a variable percentage, bcl-2 antigen. We report the case of a 50-year-old man with a large solitary fibrous tumor located in the pelvic cavity with a rare nonspecific histologic pattern of pseudovascular formations. The patient underwent pelvic exenteration with orthotopic continent urinary diversion and sigmoid-J-pouch bowel reconstruction. No signs of tumor recurrence were noted within 24 months of surgery.

[Outlet of a megaureter with aplastic kidney into a seminal vesicle cyst. Case report of laparoscopic intervention]

Unilateral cyst of the seminal vesicle, ipsilateral ectopic ureter, and ipsilateral renal aplasia are the components of a rare congenital abnormality affecting the male urogenital tract. The clinical picture is characterized by a retrovesical cystic tumor, which may cause nonspecific symptoms. Differential diagnosis includes cysts of the müllerian duct, the urogenital sinus/ejaculatory duct, and the prostate. We report a case of a left seminal vesicle cyst associated with aplasia of the left kidney in a 14-year-old boy. Preoperatively, an ipsilateral renal agenesis was suspected, but a renal aplasia with an ectopic urinary megaureter into the seminal vesicle was found intraoperatively. An 8-cm cystic left seminal vesicle and an ipsilateral renal aplasia was successfully removed by operative laparoscopy. The advantages of the laparoscopic approach over open surgery include excellent exposure of the deep pelvic structures, a short hospitalization, and a rapid recovery for the patient. We searched the literature to review the clinical presentation, diagnostic procedures, differential diagnosis, and therapeutic treatment options for this anomaly.

Urinary tract involvement by colorectal cancer

PURPOSE

Involvement of the urinary tract by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. The aim of this review is to highlight technical and oncologic issues that should be considered when dealing with complex colorectal cancer that involves the urinary tract.

METHODS

The relevant literature from 1975 to 2001 was identified using the MEDLINE database of the U.S. National Library of Medicine and reviewed. Because of the diversity of forms of presentation of urologic involvement, few randomized, controlled trials are available, with most evidence derived from retrospective studies.

RESULTS

Three distinct clinical situations in which the urinary tract may be affected by colorectal cancer were identified: involvement by primary colorectal cancer, involvement by recurrent cancer, and unexpected intraoperative findings of urinary tract involvement. Management strategies to identify and treat locally advanced primary or recurrent colorectal cancer involving the urinary tract improve survival with acceptable morbidity and mortality. Careful preoperative assessment of all patients with colorectal cancer will reduce unexpected identification of urinary tract invasion at the time of surgery. In patients in whom cure is not possible, endourologic techniques combined with judicious surgical resection can provide high-quality palliation. Optimal care of many of these conditions is facilitated by specialist urologic advice.

CONCLUSIONS

The wide spectrum of possible urinary tract involvement by colorectal cancer requires individual patient-specific and disease-specific consideration. The literature offers important guidelines that aid decision making and improve management of these challenging problems.

Radical endoscopic assisted perineal prostatectomy

PURPOSE

During radical perineal prostatectomy transection of the bladder neck and dissection of the seminal vesicles under direct vision can be difficult. We describe a technique of radical endoscopic assisted perineal prostatectomy that facilitates dissection of these structures.

MATERIALS AND METHODS

Cadaveric dissections were performed in 4 individuals to develop and assess the technique. It was subsequently applied to a 64-year-old male with clinically localized prostate cancer (Gleason grade 3+3). Management of the bladder neck and seminal vesicles was performed with a bipolar transurethral resectoscope. The remainder of the procedure was performed via a traditional subsphincteric perineal approach with the patient in the standard dorsal lithotomy position.

RESULTS

The bladder neck and seminal vesicles were successfully dissected in 55 minutes. Total operative time was 3 hours. Estimated blood loss was 500 cc. The patient was discharged home the morning of postoperative day 1 and the catheter was removed in the clinic on postoperative day 7. The final pathology report showed organ confined prostate cancer (Gleason 3+3).

CONCLUSIONS

Radical endoscopic assisted perineal prostatectomy allows precise dissection of the bladder neck and seminal vesicles under direct vision. Accomplishing this dissection as the initial step of the procedure mobilizes the prostate, facilitating excision, and obviates the need for the extreme lithotomy position.

A seminal vesicle cyst complicated with a tumor like nodular mass of benign proliferating prostatic tissue: a case report with ultrastructural and immunohistochemical studies

We report a seminal vesicle cyst complicated with a tumor-like nodular mass of benign proliferating prostatic tissue. The patient was a 53-year-old Japanese man. A cyst of approximately 4.5 cm in diameter was discovered at the left seminal vesicle area. In the inner part of the cyst, a papillary nodular mass of 0.7 cm in diameter was seen. Under the clinical diagnosis of a seminal vesicle cyst with a tumorous mural nodule, the patient underwent resection of the seminal vesicle cyst to rule out the possibility that the nodular mass in the cyst was a neoplasm of an especially malignant nature. Microscopic examination of the excised specimen revealed a small dome-like nodular mass on the luminal surface of the cyst consisting of nodular proliferation of benign tubular gland tissue with various configurations. Conventional histologic, immunohistochemical, and ultrastructural analysis showed the proliferating cells in the nodular mass consisted of the benign prostate type. It is extremely important to differentiate between a benign proliferation and a malignant one, when the nodular mass is found in the seminal vesicle cyst.

Outcome in patients with seminal vesicle invasion after radical cystectomy

PURPOSE

We evaluated the impact of seminal vesicle invasion by transitional cell carcinoma of the bladder in a large cystectomy series.

MATERIALS AND METHODS

Between January 1985 and February 2002, 1,125 cystectomies were performed at our 2 institutions. In 68 male patients there was pathologically proved tumor extension to the perivesical fat, prostatic stroma and/or seminal vesicles, including group 1: 38 to the prostatic stroma alone, group 2-12 to the seminal vesicles alone, and group 3-18 to the seminal vesicles and prostatic stroma. Complete followup was available for all patients. Overall disease specific and progression-free survival rates were calculated using the Kaplan-Maier-Method. Survival rates were compared using the log rank test.

RESULTS

The overall 5-year survival rate for all 68 patients was 23.1%. The 5-year disease specific survival rates were 41.1%, 0% and 0%, and the 5-year progression-free survival rates were 32.1%, 0% and 0% for groups 1 to 3, respectively. Survival was significantly decreased in patients with seminal vesicle infiltration with or without prostatic stromal infiltration compared with prostatic involvement alone. This difference was independent of lymph node status in groups 1 versus 2 and 3.

CONCLUSIONS

Seminal vesicle invasion by bladder carcinoma has a significant impact on disease specific and progression-free survival compared with prostatic stromal involvement alone.

Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy

OBJECTIVES

To compare the perioperative morbidity and surgical technique of the two main variants of laparoscopic radical prostatectomy: the more often used transperitoneal approach with primary dissection of the plane posterior to the seminal vesicles (TP-LRP) and a purely extraperitoneal approach (EP-LRP).

METHODS

Our initial 20 consecutive patients who underwent EP-LRP and the last 20 consecutive patients who underwent TP-LRP were included in this retrospective study. The two groups were well matched for age, American Society of Anesthesiologists score, body mass index, prostate-specific antigen level, and Gleason score. The mean time for completion of the individual laparoscopic steps was assessed for both approaches.

RESULTS

With EP-LRP, the mean operative time was shorter (169.6 minutes versus 224.2 minutes, P <0.001) and patients resumed a full diet earlier (mean 1.6 days versus 2.6 days, P = 0.002). The mean total dose and duration of morphine administration were higher in the TP-LRP group, but the difference was not statistically significant (6.0 mg versus 12.8 mg and 0.5 day versus 0.9 day, respectively). The catheter time was nearly identical in the two groups (mean 5.3 days with TP-LRP and 4.2 days with EP-LRP). The incidence of positive margins was not affected by the surgical approach.

CONCLUSIONS

These preliminary results suggest that the initial posterior dissection associated with TP-LRP is less efficacious than direct access of the prevesical space during EP-LRP. Measures of perioperative morbidity were at least equivalent, if not superior, for the EP-LRP technique. These findings, together with the significant decrease in operative time with EP-LRP, appear sufficiently important to abandon the transperitoneal technique.

[Treatment of excretory azoospermia. Biological aspects of surgery]

The therapeutical strategy for excretory azoospermia is very efficient at the present time. It is represented by two complementary methods very different both in their concept and their practical aspects. The surgery for recanalisation of the seminal tract is the old method, associated with reproducible and validated results providing a sophisticated operative methodology which implies microsurgery. The recent introduction of the assisted reproduction technics with better or at least equal results than those of surgery and with a growing therapeutical power already nowadays offers satisfying opportunities of treatment in some selected indications. The evolution of the therapeutical strategy is analyzed through our proper practice and the data of the literature.

Cystosarcoma phyllodes of the seminal vesicle

BACKGROUND

We report here an extremely rare case of cystosarcoma phyllodes of the seminal vesicle.

METHODS

A 65-year-old man presented with urinary hesitancy, frequency and constipation. Clinical examinations including two needle biopsies were performed, and the patient had undergone open surgery.

RESULTS

The final pathological diagnosis was cystosarcoma phyllodes of the seminal vesicle. Seven months after the operation, a chest X-ray showed lung metastasis, and the patient died 11 months after the operation.

CONCLUSION

To our knowledge, only one case of cystosarcoma phyllodes of the seminal vesicle has been previously reported.

Schwannoma of a seminal vesicle

We present the first reported case of a schwannoma of the seminal vesicle that occurred in a 48-year-old man who presented with right lower quadrant abdominal pain. Computed tomography scan and magnetic resonance imaging revealed a mass in the patient's right seminal vesicle. The patient was also found to have a rising prostate-specific antigen level and underwent a transrectal ultrasound-guided biopsy of the prostate and seminal vesicles, which revealed prostate cancer and schwannoma of the seminal vesicle, respectively. Radical prostatectomy with en bloc removal of the seminal vesicle mass was performed and the patient has been free of disease 24 months postoperatively.

Transutricular seminal vesiculoscopy

Disorders of the seminal vesicle have been evaluated mainly via imaging techniques. We developed a technique to examine the interior of seminal vesicles endoscopically. In 37 hemospermic patients, transrectal ultrasound (TRUS) or endorectal MRI were performed preoperatively. When the patients had definite abnormalities on the imaging studies and did not improve after medication over a period exceeding 3 months, transutricular seminal vesiculoscopy was performed using a 6F or a 9F rigid ureteroscope. Patients were then followed for at least 3 months. Endoscopic evaluation was also performed in two patients with stage B(1) and D(2) prostate carcinoma. In hemospermic patients, hemorrhage was found in the seminal vesicles or the ejaculatory ducts in 23 (62.2%) and 3 (8.1%), respectively. Calculi were present in the seminal vesicles or ejaculatory ducts in 6 (16.2%) and 2 (5.4%), respectively. In prostate carcinoma patients, seminal vesiculoscopy was similarly informative. Postoperative complications, including epididymitis or retrograde ejaculation, were not observed. Transutricular seminal vesiculoscopy can be performed easily with conventional endoscopic equipment and provides useful information.

The management of stress urinary incontinence after radical prostatectomy

Up to 30% of patients complain about urine leakage after radical prostatectomy, but persistent stress incontinence (beyond 1 year) affects <5% of them. This complication is mainly caused by sphincter dysfunction. Some preventive measures have been described to decrease the risk of incontinence after radical prostatectomy, but with conflicting results. The effectiveness of preoperative and early postoperative physiotherapy is controversial. Moreover, while meticulous apical dissection of the prostate significantly improves postoperative continence, the benefit of other surgical techniques, e.g. preserving the bladder neck and the neurovascular bundles, is under debate. The treatment of persistent stress urinary incontinence is mainly based on surgery, as this type of incontinence usually does not respond to physiotherapy and anticholinergic medication. While injection therapy is safe and well tolerated, its effect on postoperative continence is limited and decreases with time. The best results are achieved by implanting an artificial urinary sphincter, but with significant complication and revision rates.

Laparoscopic radical prostatectomy: a European virus with global potentials

OBJECTIVES

To review the current status of the Laparoscopic Radical Prostatectomy in Europe (LRP).

METHODS

The published peer reviewed articles on the experience of the European groups performing Laparoscopic Radical Prostatectomy.

RESULTS

Three different approaches have been described for LRP, two of them transperitoneally (early dissection of seminal vesicles or of the prostatic apex) and one totally extra peritoneally. Results in terms of per operative performances and immediate outcomes seem to be comparable with the exception of the bleeding and the transfusion rate that seem higher in the transperitoneal approach with early dissection of the prostatic apex. Conversion rates have been described up to 5% but it is rare after the 20 first cases; after the learning curve has been overcome the complication rate varies between 10% and 17%. Being a novel technique, all the series have a short median follow-up of around one year. The one-year continence rates are comparable to the ones described with the classical open approach, as it is the potency rate. The rate of positive margins bounces between 2 and 49% depending mainly on case selection. A long and steady learning curve burdens the technique in terms of complications.

CONCLUSIONS

LRP is feasible, teachable and reproducible. Although no comparative series with the open approach are available yet, functional and oncological results seem to be comparable to the ones reached after open Retropubic Radical Prostatectomy.

Partial vesiculectomy in an infertile man with seminal vesicle cyst, ipsilateral renal agenesis, and cryptorchidism

Congenital seminal vesicle cysts associated with renal agenesis are uncommon, but are currently detected more frequently with the use of sectional imaging procedures. Approximately 200 cases have been reported. The unique feature of our case is the combination of this disorder with an ipsilateral undescended testis. Our patient underwent partial vesiculectomy, in which the cyst was removed and the seminal vesicle remnant with its vas deferens was preserved. A review of the infertile cases and the impact of surgical treatment on fertility are discussed. Features that render partial vesiculectomy applicable and the potential effect of this procedure on fertility are highlighted.

Squamous cell carcinoma arising from a seminal vesicular cyst: possible relationship between chronic inflammation and tumor development

A case of squamous cell carcinoma arising within an acquired seminal vesicular cyst is described. A 61-year-old man was hospitalized because of hemospermia and dysuria. Under the diagnosis of a left seminal vesicular cyst, surgical resection was performed. Pathological examination revealed squamous cell carcinoma within a seminal vesicular cyst, along with squamous metaplastic foci and severe chronic inflammation. Cell proliferation, determined with reference to MIB-1 labeling indices, showed a stepwise increase from normal columnar epithelium, through squamous metaplasia, to squamous cell carcinoma. Sporadic p53 protein accumulation without evident gene mutations was also apparent in both the carcinoma and squamous metaplastic lesions. We therefore concluded that the squamous cell carcinoma might have developed from squamous metaplastic foci associated with chronic inflammatory stimulation, within a seminal vesicular cyst.

[Can a precise vesiculectomy be performed during radical prostatectomy?]

OBJECTIVE

To define the anatomical landmarks allowing precise vesiculectomy to be performed during radical prostatectomy for cancer.

MATERIAL AND METHODS

12 non-formalin-preserved anatomical subjects were dissected as during retropubic and perineal prostatectomy, with and without coloured latex vascular injection.

RESULTS

Three anatomical landmarks were defined: 1) Denonvilliers' fascia; 2) vas deferens; 3) arteries supplying the seminal vesicles.

CONCLUSIONS

These three anatomical landmarks ensure: complete resection, preservation of adjacent anatomical structures and elective haemostasis.

Cystadenoma of the seminal vesicle: report of a case with ultrastructural findings

Cystadenomas of the seminal vesicles are extremely rare benign tumours. We have not been able to find more than 10 cases in the literature. A benign cystadenoma of the seminal vesicle is described in a 49-year-old man. The clinical presentation, gross appearance, microscopic characteristics, immunohistochemical and ultrastructural findings of this uncommon tumour are discussed. The purpose of this paper is to report an unusual case of cystadenoma of the seminal vesicle and review the 10 previously reported cases in the English literature.

Reconstruction of seminal ducts in obstructive azoospermia

Depending on the localization of the obstruction of the seminal ducts, either a microsurgical reconstruction (tubulovasostomy, vasovasostomy) or a transurethral resection of the ejaculatory ducts is carried out. We have compared the effectiveness and economic advantages of reconstructive microsurgery of the epididymis and vas deferens with standard procedures in animal experiments. Microsurgical invagination techniques in tubulovasostomy are equal to the standard procedure from the point of view of the patency and fertility rates. They are also easier to learn and carry out. Less time is required for the invagination technique, and also less microsurgical suture material. The double-layer technique in vasovasostomy is equal to the one-layer microsurgical technique from the point of view of patency and fertility rates. The one-layer technique requires less time and suture material. It seems that the discrepancy between the patency and the fertility rate is related to immunological processes after reconstruction of the seminal ducts. In cases of obstructive azoospermia it is necessary to investigate the individual conditions and possibilities of the infertile couple. As a result of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken.

[Transurethral treatment of seminal vesicle abscess]

An 83-year old male with a seminal vesicle abscess is presented. Initially, cancer of the prostate was suspected and the findings of the transrectal ultrasound scan were misinterpreted. The diagnosis was made by CT-scan. When drainage failed the patient was treated successfully with transurethral unroofing.

Improving bladder neck division in radical retropubic prostatectomy by prior dissection of the seminal vesicles and vasa deferentia

OBJECTIVE

To develop a convenient technique for dividing the bladder neck during radical retropubic prostatectomy.

METHOD

Before opening the bladder, we created a plane that separates the anterior surface of the seminal vesicles from the posterior wall of the bladder and ran an umbilical tape through the plane. The posterior bladder neck wall was later divided using this tape as a guide mark.

RESULTS AND CONCLUSION

The posterior bladder neck was divided in a single, easy, and swift maneuver (less than 2 min) in 350 patients with no subsequent complications.

Duplicated seminal vesicle

We report a case of complete, unilateral seminal vesicle duplication without concomitant reproductive duct or renal anomalies encountered during radical retropubic prostatectomy. We also discuss the possible embryologic origin of this anomaly and the clinical implications.

Seminal vesicle cystadenoma: a case report and literature review

Primary tumors of the seminal vesicle are rare; most reported cases are carcinomas, with occasional reports of primary seminal vesicle sarcoma and an uncommon group of mixed epithelial-stromal tumors. The latter have been variably reported in the literature as cystadenoma, phyllodes tumor, and mullerian adenosarcoma-like tumor. We describe a 37-year-old man who presented with symptoms of bladder outlet obstruction and was found to have a pelvic mass. Resection of the mass yielded a biphasic tumor characterized by cystically dilated glandular spaces admixed with spindle-shaped stromal cells. There was no significant cytologic atypia or mitotic activity. The histologic features are most consistent with the reported cases of cystadenoma. The patient is alive, with no evidence of disease, 6 months after surgery. This case adds to the gradually growing body of literature on mixed epithelial-stromal tumors of the seminal vesicle.

Initial dissection of the lateral fascia reduces the positive margin rate in radical prostatectomy

OBJECTIVES

Positive margins predict an adverse outcome after radical retropubic prostatectomy (RRP). The effect of initial incision of the lateral pelvic fascia prior to urethral transection on positive margins rates is assessed.

METHODS

The rate of positive margins in 350 consecutive RRPs is compared in two groups without hormonal pretreatment. In group 1 (n = 198), RRP was performed in standard fashion with apical dissection and urethral transection preceding dissection of the lateral pelvic fascia and mobilization of the prostate from the anterior rectal surface. In group 2 (n = 1 52), the initial step consisted of incision of the lateral pelvic fascia along the perirectal surface with prostatic mobilization off the rectum prior to urethral transection. The bladder neck and seminal vesicle dissection was identical in both groups. Specimens were step-sectioned for histologic analysis. Differences in rates of positive margins were analyzed by Fisher's exact test and logistic regression.

RESULTS

The rate of positive margins was reduced from 37.4% in group 1 to 15.8% in group 2. In the logistic regression model, surgical technique, Gleason sum, serum prostate-specific antigen (PSA), and the presence of extracapsular extension were independent predictors of margin status, with group 1 being more than twice as likely to have positive margins than group 2 (P = 0.0076; odds ratio 2.198; 95% confidence interval 1.23 to 3.92). The rate of positive margins was reduced from 45.5% in group 1 to 16.7% in group 2 (P = 0.0046) for non-nerve-sparing RRP and from 33.3% to 15.5% (P = 0.0012) for nerve-sparing RRP. There were no differences in functional outcomes between groups and no rectal injuries in group 2.

CONCLUSIONS

Initial dissection of the lateral pelvic fascia during RRP results in a lower rate of positive margins independent of tumor grade, clinical stage, extracapsular extension, and preoperative PSA level.

Early prostate-specific antigen failure following radical perineal versus retropubic prostatectomy: the importance of seminal vesicle excision

OBJECTIVES

Because of renewed interest in the radical perineal prostatectomy, we chose to evaluate factors influencing differences in biochemical failure as measured by prostate-specific antigen (PSA) between radical perineal and the radical retropubic prostatectomies.

METHODS

We undertook a retrospective review of 87 men with clinically localized prostate cancer who underwent radical retropubic (64%) or radical perineal (36%) prostatectomy, noting age, race, preoperative PSA, Gleason score, clinical stage, capsular penetration, surgical approach, and completeness of seminal vesicle (SV) excision. The two groups were comparable with respect to tumor factors such as preoperative PSA, Gleason score, clinical stage, and capsular penetration. Time to postoperative PSA failure (0.2 ng/mL or greater) was evaluated with univariate and multivariate analysis of multiple contributing factors.

RESULTS

Twenty-eight percent of patients had a PSA level rising to 0.2 ng/mL or greater in the follow-up period. Patients who underwent perineal prostatectomy had a higher PSA failure rate (45%) than those treated by the retropubic approach (18%) and patients with incomplete SV excision had a higher failure rate (69%) than patients with bilateral SV excision (20%). When time to PSA failure was examined by multivariate analysis, completeness of SV excision, clinical stage, and Gleason score had a statistically significant impact on this outcome. In perineal prostatectomy patients, bilateral SV excision had a significantly longer time to PSA failure than in patients with incomplete excision. There was no significant difference in time to PSA failure between patients who underwent radical retropubic prostatectomy and the patients who underwent perineal prostatectomy with bilateral SV excision.

CONCLUSIONS

Incomplete excision of SVs during a radical perineal prostatectomy contributes to an earlier postoperative biochemical recurrence as measured by a rising PSA, and may explain the higher disease recurrence rate for radical perineal prostatectomies as opposed to radical retropubic prostatectomies in this study.

[Biopsy of the seminal vesicles in the staging of localized cancer of the prostate: technic and results]

OBJECTIVE

To allow the diagnosis of pathological stage C prostatic cancer before deciding on treatment.

METHOD

Seminal vesicle biopsy was performed as an outpatient procedure without anaesthesia. An identical antibiotic prophylaxis to that used for prostatic biopsy was performed. Biopsies were performed by longitudinal vision using a transrectal probe. A seminal vesicle needle biopsy was performed lateral to the prostate in the medial third of the seminal vesicle.

RESULT

When seminal vesicle biopsies are positive, the final pathology report after radical prostatectomy confirmed the diagnosis in 100% of cases. When seminal vesicle biopsies were negative, seminal vesicle invasion was detected on the final pathology examination in one third of cases, mostly corresponding to exclusively intraprostatic involvement of the seminal vesicle. Biopsies are useful when at least one of the two prostatic bases is involved. In the series of the last 42 radical prostatectomies performed because of negative seminal vesicle biopsies, we detected only 11% of capsular lesions, almost always less than 1 mm, and 0% of ilio-obturator lymph node invasion.

CONCLUSION

Although the digital rectal examination findings, the PSA level, the Gleason score, and the number of positive biopsies and their length, allow an approach to preoperative staging, only seminal vesicle biopsies can provide a better preoperative staging of prostatic cancer for a given patient and no longer just statistically.

[Seminal vesicle cyst and ipsilateral kidney failure. Report of 2 cases and review of the literature]

The seminal vesicle cyst is a congenital malformation of the male urogenital tract, which seems to be more frequent than originally presumed. It is usually combined with an ipsilateral renal agenesis and an ectopic ureter. Two relevant cases are reported and embryology, major presenting symptoms, diagnostic procedures, differential diagnosis and therapy are extensively discussed.

Delayed/salvage radiation therapy in patients with elevated prostate specific antigen levels after radical prostatectomy. A long term follow-up

BACKGROUND

In this article the authors report an analysis and long term results of delayed/salvage radiation therapy administered to asymptomatic patients who had an elevated prostate specific antigen (PSA) level, many months to many years after radical prostatectomy.

METHODS

During 1987 to 1990, 40 asymptomatic patients were found to have an elevated PSA level 9 to 96 months after radical prostatectomy. The patients underwent transrectal needle aspiration biopsy of the urethrovesicle junction anastomosis (uvj); 28 patients had a positive biopsy and 12 patients had a negative biopsy. Delayed/salvage radiation therapy was administered to the pelvis (45 Gray [Gy]) and prostate bed (59.5 Gy), including the uvj.

RESULTS

Twenty-four of 37 patients (65%) were free of clinical disease. In 10 patients (27%), the radiation therapy resulted in a durable decrease in the elevated PSA level below a detectable level for a minimum 5-year follow-up. Five patients were alive with clinical disease. Eight died of disease. Three patients were lost to follow-up.

CONCLUSIONS

This experience shows that delayed/salvage radiation therapy to the pelvis (45 Gy) and prostate bed (59.5 Gy), even many years after radical prostatectomy for pathologic stage pB, pC, and pD1 carcinoma of the prostate, was well tolerated and provided freedom from clinical disease in 24 of 37 patients (65%), and a decrease in elevated PSA level in 10 patients (27%). Delayed/salvage radiation therapy appears to be beneficial for patients who had undergone radical prostatectomy only and then developed rising PSA levels during the follow-up period.

Radical prostatectomy: is complete resection of the seminal vesicles really necessary?

PURPOSE

We determined the frequency of prostate cancer extension into the distal 1 cm. of seminal vesicles, and reconsidered whether complete excision of the seminal vesicles during radical prostatectomy is always necessary.

MATERIAL AND METHODS

After en bloc removal with the specimen in 71 consecutive radical prostatectomies, the distal 1 cm. of each seminal vesicle was transected and separately analyzed for tumor involvement.

RESULTS

Mean patient age was 61.8 years (range 40 to 72). Preoperative prostate specific antigen (PSA) ranged from 0.8 to 37 ng./dl. (median 7.3), and 18 patients had a PSA of 10 or more. Clinical stages were T1b in 1 case T1c in 37, T2a in 12, T2b in 10, T2c in 6 and T3a in 1. Preoperative Gleason sums ranged from 4 to 8 (median 6) with 21 patients (30%) having a sum of 7 or more. Of 71 patients 12 (17%) and seminal vesicle invasion (5 bilaterally). In no case did tumor extend into the distal 1 cm. of the seminal vesicle. PSA at diagnosis ranged from 4.2 to 30 ng./dl., with 4 of 12 patients having a PSA of 10 or more. Preoperative clinical stages were T1c in 5 cases, T2a in 3, T2b in 2 and T2c in 2. Five of the 12 patients (42%) had positive surgical margins and 11 (92%) had a postoperative Gleason sum of 7 or more.

CONCLUSIONS

In 71 consecutive patients undergoing radical prostatectomy no tumor was found in the distal 1 cm. of the seminal vesicles, including 12 with seminal vesicle invasion. We continue to advocate complete excision of the seminal vesicles during radical prostatectomy. However, if dissection is difficult and a small fragment is left behind, the prognosis is unlikely to be altered.

Role of laparoscopy in the diagnosis and treatment of prostate cancer

Laparoscopic surgical techniques were originally applied to the staging of prostate cancer in the form of laparoscopic pelvic lymph node dissection. The efficiency of laparoscopic pelvic lymph node dissection has proven to be comparable to open lymphadenectomy in tissue yield and also shows a considerable decrease in postoperative morbidity. Subsequently, laparoscopy has been used as an adjuvant to perineal prostatectomy for preliminary dissection of the seminal vesicles. Laparoscopic radical prostatectomy has been performed but the long-term efficacy of this treatment is unknown at this point. Future clinical applications of laparoscopic surgical techniques in the diagnosis and treatment of prostate cancer include harvesting of primary and metastatic prostatic tissue for adjuvant gene therapies for prostate cancer.

Increased secondary sex ratios in golden hamster litters sired by males without coagulating glands and seminal vesicles

In golden hamsters, although bilateral ablation of paternal coagulating glands (CGX) and seminal vesicles (SVX) did not affect fertility, a higher number of male pups were born. The present study aimed at determining whether this male-biased sex ratio was due to an imbalance of fertilization by X and Y chromosome-bearing sperms or whether it was the consequence of a sex-related differential survival of embryos. The sex of embryos sired by sham-operated (SH) controls or males subjected to bilateral ablation of ampullary glands (AGX), CGX and SVX was determined from chromosomal spreads at 10 h post coitum and 10 days post coitum. The primary sex ratio of of the SH group did not deviate from the hypothetical sex ratio of 1:1. The sex ratios of zygotes from the three experimental groups did not differ from that of the controls. However, by mid gestation, the sex ratio was significantly higher in the SVX group (P < 0.05) and the CGX group (P < 0.005). The absence of secretions from the ampullary gland, coagulating gland and seminal vesicle had no effect on the primary sex ratio, thus these glands did not appear to affect fertilization by the X and Y chromosome-bearing sperm. The increased secondary sex ratios observed in the SVX and CGX groups were due to the preferential survival of males.

[The value of computer tomography for diagnosis of seminal vesicle cysts]

Presented report deals with the case of a giant cyst of the left seminal vesicle with major diagnostic difficulties. After urography, cystoscopy, and computer tomography all symptoms in patient with cyst disappeared, and the tumor was not stated during physical examination. Six months later all symptoms in the patient exaggerated. Among diagnostic procedures used only computer tomography visualized giant cyst of the seminal vesicle which occupied the whole pelvis. After surgical excision of the cyst the patient had and erectile dysfunction.

Ectopic ureter opening into the seminal vesicle in an infant: a case report and review of the Japanese literature

A case is presented of an ectopic ureter opening into the seminal vesicle associated with hypodysplastic kidney in an infant. We reviewed 135 cases (139 ureteral units) of male ectopic ureter from the Japanese literature and, of the 139 ectopic ureters, 109 were single-system ectopic ureters, and 26 ureters were associated with the ureteral duplication. Sixty-three and 73 ureters opened into the urinary tract and seminal tract, respectively. In patients 15 years or older, 65 cases of ectopic ureter opened into the seminal tract and 33 cases opened into the urinary tract, whereas in children under 15 years, the ectopic orifice was located more often in the urinary tract (26 cases) than in the seminal tract (8 cases). Presenting symptoms differed according to the location of the ectopic orifice. Ectopic ureters opening into the urinary tract most often presented with urinary tract infection and abdominal or lumbar pain. On the other hand, voiding and ejaculatory symptoms as well as perineal or genital pain were characteristic in ectopic ureters opening into the seminal tract. Of the 83 associated renal segments that were surgically removed, dysplasia, hypoplasia and aplasia were found in 22, 24, 14 cases, respectively. It was noteworthy that 48 of the 53 single ectopic ureters opening into the seminal vesicle were associated with ipsilateral renal dysgenesis.