Open Journal of Urology, 2013, 3, 256-260
http://dx.doi.org/10.4236/oju.2013.36048 Published Online October 2013 (http://www.scirp.org/journal/oju)
Radiological Evaluation of Lower Genitourinary
Tract Cysts in Males*
Ashraf Talaat Youssef
Department of Radiodiagnosis, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
Received September 7, 2013; revised October 5, 2013; accepted October 13, 2013
Copyright © 2013 Ashraf Talaat Youssef. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aim of the Work: The present wok aims to assess how to reach the optimum diagnosis of the nature and the complica-
tions of lower genitourinary tract cyst in male patient using different radiological imaging modalities. Patients and
Methods: 1000 male patients were evaluated with pelvic ultrasound and if lower genitourinary tract cysts were present,
the patients were further subjected to either trans-rectal ultrasound (TRUS), TRUS guided aspiration for presence of
spermatozoa, TRUS guided seminal vesiculography or CT urography in order to reach the origin of the cyst and the
complications of its presence. Results: 14 cases were detected with lower genitourinary tract cysts among our patients
with an overall incidence 1.4%; among th em 3 patients with mid line prostatic cysts sho wed normal seminal analysis; 1
patient with prostatic cyst was infertile; 3 patients were detected with infravesical cysts after transurethral resection
prostatectomy; 2 cases with small retention cysts were associated with benign prostatic hyperplasia; 1 case was detected
with prostatic abscess; 1 patient was detected with unilateral ureterocele; 1 patient was detected with large pelvi ab-
dominal unilateral seminal vesicle cyst; 1 patient was with unilateral ejaculatory duct cyst; 1 patient with small cystic
dilation of pr os t a t ic urethra w a s associat ed wi t h urethral stone.
Keywords: Cyst; Genitourinary; Male; Radiological
Cysts of the prostate gland can be classified into 6 cate-
gories, including 1) isolated medial cysts; 2) cysts of the
ejaculatory duct; 3) simple or multiple cysts of the pa-
renchyma; 4) complicat e d infectious or hemorrhagic cysts;
5) cystic tumors; and 6) cysts secondary to parasitic dis-
ease . Mid line prostatic cysts may contain sperms as
ejaculatory duct and vas deference cysts or may be sperms
free as utriculus and Mullerian duct cysts [2,3]. Seminal
vesicles cysts are discovered incidentally, contain sper-
matozoa, may cause urinary symptoms and may be asso-
ciated with unilateral renal agenesis or adult polycystic
kidneys. Ejaculatory duct cysts could be congenital or
acquired due to distal stenosis or obstruction which may
lead to azoospermia and low or absent seminal fructose
[4,5]. Prostatic cysts may be asymptomatic or may be
associated with lower urinary tract irritative or obstruc-
tive symptoms and can lead to hematospermia or infertil-
ity [6-11]. Radiological evaluation of lower genitourinary
tract cysts includes pelvic ultrasound, transrectal ul-
trasound (TRUS), computed tomography, magnetic reso-
nance imaging, TRUS guided aspiration of cyst contents
and TRUS guided seminal vesiculography [4,12-15].
2. Aim of the Work
The present wok aims to assess how to reach the opti-
mum diagnosis of the nature and the complications of
lower genitourinary tract cyst in male patient using dif-
ferent radiological imaging modalities.
3. Patients and Methods
1000 male patients were complaining of lower urinary
tract obstructive or irritative symptoms, their age range
from 25 to 65 years and the mean age was 35 years, all
were referred to pelvic ultrasound exam with Sonoace x8
ultrasound machine (Medison, Korea) using 3.5 mhz
convex ultr asound prob e between Octob er 2009 an d May
2013 and if lower genitourinary tract cyst was present,
the patients were further subjected to either trans-rectal
ultrasound (TRUS), TRUS guided aspiration for presence
of spermatozoa, TRUS guided seminal vesiculography or
*Conflict of Interest: not present.
Sources of Fundin g: not present.
opyright © 2013 SciRes. OJU
A. T. YOUSSEF 257
CT urography in or der to reach the origin of the cyst and
the complications of its presence. TRUS guided aspira-
tion was done through introducing of 22 G needle into
the cyst guided with ultrasound to aspirate the contents
and TRUS guided seminal vesiculography was done
through introducing 22 G needle into the seminal vesi-
cles with injection of contrast media into each seminal
vesicle. Patency of ejaculatory duct was diagnosed when
filling of posterior urethra and urinary bladder with con-
trast media observed during injection [12-14].
14 cases were detected with lower genitourinary tract
cysts among our patients with an overall incidence 1.4%
3 patients with mid line prostatic cysts showed normal
seminal analysis, TRUS guided aspiration of cyst con-
tents revealed no sperms suggesting either utriculus or
Mullerian duct cysts (Figures 1 and 2).
Figure 1. (a), (b): Small prostatic cyst seen at periphery of
prostate adjacent to the urinary bladder nec k.
Figure 2. Small asymptomatic mid line prostatic cyst.
1 patient with prostatic cyst was infertile and showed
azoospermia on seminal analysis with no filling of po ste-
rior urethra or urinary bladder with contrast during TRUS
guided seminal vesiculography denoting bilateral ejacu-
latory ducts obstruction (Figures 3(a) and (b)).
3 patients were detected with infravesical cysts after
transurethral rese ction prost a tectom y.
2 cases with small retention cysts were associated with
benign prostatic hyperplasia.
1 case with prostatic abscess showed severe lower uri-
nary tract irritative symptoms, rectal pain and showed
intraprostatic thick walls cavity with turbid contents that
was markedly tender on probing (Figure 4).
1 patient was detected with unilateral ureterocele seen
as distal localized fusiform dilation in the intramural
course of ureter (Figure 5).
1 patient was detected with large pelvi abdominal cyst
was complaining of severe lower urinary tract irritative
symptoms with rectal heaviness and tenesmus, the cyst
contents was turbid by ultrasound and further CT with
contrast revealed that the cyst was originating from the
right seminal vesicle and diagnosed as a rare case of
large pelvi abdominal unilateral seminal vesicle cyst
(Figures 6 (a)-(d)).
1 patient with oligospermia showed unilateral ejacula-
tory duct cyst and was diagnosed with TRUS as small
cystic swelling in the course of ejaculatory duct and
TRUS guided aspiration revealed the presence of sperms.
1 case showed small localized cystic dilation of p r o st a t ic
urethra associated with small stone at distal prostatic
In spite of being very uncommon, lower genitourinary
tract cysts in males may lead to male infertility, lower
urinary tract obstructive and irritative symptoms and he-
matospermia [7 -11]. With the use of TRUS, TRUS gu i d ed
aspiration of the cyst, TRUS guided seminal vesiculo-
Copyright © 2013 SciRes. OJU
A. T. YOUSSEF
Figure 3. (a), (b): Prostatic cyst casting ejaculatory duct
obstruction. (a) 3 dimensional ultrasound of large mid line
prostatic cyst; (b) TRUS guided seminal vesiculography
showing non filling of posterior urethra or urinary bladder
denoting ejaculatory duct obstruct ion.
graphy and in selected cases CT urography in addition to
the pelvic ultrasound, we can reach an accurate diagnosis
to ensure an optimum way of management.
The differentiation between Mullerian duct cyst and
utriculus cyst which are better referred as prostatic cyst is
difficult as both occurs in midline of prostate and may
cause infertility through compression or deviation of the
ejaculatory ducts and both are sperm free; however, the
differentiation is not important as both are treated with
Figure 4. Pelvic ultrasound show ing lar g e pr ostatic absc ess.
Figure 5. (a) Pelvic ultrasound showing right ureter ocele; (b)
3 dimensional ultrasound of right urete r ocele.
transurethral resection . Many of them are asympto-
matic but with the presence of azoospermia, TRUS gu i ded
seminal vesiculography was helpful to assess the pres-
ence of bilateral ejaculatory duct obstruction and the
need for cyst resection.
Copyright © 2013 SciRes. OJU
A. T. YOUSSEF
Copyright © 2013 SciRes. OJU
Figure 6. (a): B mode ultrasound showing pelvi-abdominal oblong shape cyst; (b)-(d): CT abdomen with contrast showing
post billharzial calcified seminal vesicles with large pelvi-abdominal cyst (blue arrow) originating from the right seminal vesi-
cle. (b): axial scan, (c): coronal scan and (d): sagittal scan.
Prostatic abscess was diagnosed by the clin ical pictur e,
the presence of intraprostatic thick walls turbid contents
cavity with marginal hyperemia and by the presence of
pus during TRUS guided aspiration.
Retention prostatic cysts are small anechoic clear con-
tent cysts seen in association with benign prostatic hy-
Ejaculatory ducts and vas deference cysts were diag-
nosed by their anatomical location in course of the
ejaculatoy duct or the vas deference during TRUS and by
the presence of spermatozoa in the aspirate using TRUS
guided aspiration [7,16].
Seminal vesicles cysts were diagnosed with pelvic ul-
trasound and TRUS by their origin from the seminal
vesicles and in rare cases presented with plevi-abdominal
swelling, CT with contrast proved useful in localizing
Ureteroceles are easily diagnosed by their characteris-
tic location in intramural course of ureter.
In cases of Infra vesical cysts, after transurethral re-
A. T. YOUSSEF
section prostatectomy, the diagnosis can be reached from
the history and the characteristic funneling in the course
of prostatic urethra.
Lower genitourinary tract cystic lesions are very uncom-
mon in males and an accurate diagnosis of the nature and
the complications of the cysts can be reached through
good combination between various radiological imaging
modalities, which is essential to reach the optimum way
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