0022-5347/99/1622-049810 THE JOURNAL OF UROIDGY Copyright 8 1999 by AMERICAN UROLOCICAL A s s o c l ~ T l O N , INC.

Vol. 162,498-499, August 1999 Printed in U.S.A.

LAPAROSCOPIC EXCISION OF SEMINAL VESICLE CYSTS

OSAMU IKARI, LISIAS N. CASTILHO, ROBERTO LUCENA, CARLOS A. L. DANCONA AND NELSON RODRIGUES NETTO, JR.

From the Division of Urology, University of Campinas Medical Center, Unicamp, ScIo Paulo, Brazil

KEY WORDS: seminal vesicles, cysts, laparoscopy

Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two-thirds are as- sociated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle.' Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis.2 We report 2 cases of video laparo- scopic ablation of seminal vesicle cysts.

CASE REPORTS

Case 1. A 24-year-old white man presented with left pelvic colic pain 3 months in duration. Physical and digital rectal examinations were normal. A 5 cm. left seminal vesicle cyst was demonstrated on excretory urography (fig. 1, A), ultra- sonography and computerized tomography (CT) of the pelvis and abdomen (fig. 1, B).

Video laparoscopic excision of the left seminal vesicle was performed with the patient under general anesthesia. A Ve- ress needle was introduced transumbilically and the perito- neal cavity was filled with carbon dioxide until pressure was 20 mm. Hg. The first 11 mm. trocar was blindly introduced into the peritoneal cavity through the navel, and the abdo- men was examined with a 0-degree optical lens. The auto- matic pump was regulated to work at a maximum pressure of 18 mm. Hg and 3 more trocars were introduced under direct vision, including an 11 mm. trocar in the middle 3 cm. above the pubis, and 2 other 5 mm. trocars on both sides lateral to the recto-abdominal muscles and a short distance below the umbilicus.

The surgical table was placed in the Trendelenburg posi- tion and the cyst was easily identified by a transverse inci- sion in the retrovesical peritoneum. The left vas deferens was sectioned and dissected medial up to the ampulla, close to the seminal vesicle and cyst to avoid injury to the adjacent or- gans. The seminal vesicle artery was clipped and sectioned, and the cyst was punctured and emptied. The cyst and sem- inal vesicles were removed through the suprapubic trocar after clipping the ejaculatory duct. Carbon dioxide pressure was reduced to 6 mm. Hg and the trocars were removed

Accepted for publication March 19, 1999.

FIG. 1. A, excretory urography shows fillin defect on left lateral wall of bladder and no absence of ipsilateral fudney. B, CT reveals left seminal vesicle cyst.

under direct vision. The surgical incisions were sutured only after all carbon dioxide was completely removed from the peritoneal cavity.

Total operating time was 90 minutes, convalescence was uneventful and the patient was discharged from the hospital 48 hours after surgery. A transrectal ultrasound was normal after 120 days, except for absence of the left seminal vesicle. The patient was asymptomatic with preserved ejaculation after 24 months of followup.

Case 2. A 10-month-old yellow child presented with recur- rent gram-negative urinary infection and bilateral epididy- mitis since birth. Digital rectal examination revealed a large fibroelastic tumor in the prostate region with no definable limits. Ultrasonography showed a 5 cm. retrovesical cystic tumor which was confirmed on magnetic resonance imaging (MRI) (fig. 2). The same aforementioned technique was used in this patient except the pneumoperitoneum pressure was reduced to 12 mm. Hg.

Total operating time was 120 minutes and patient was discharged from the hospital 2 days postoperatively. The child is completely asymptomatic and has not had a urinary infection since January 1995.

DISCUSSION

Until 1986 only 50 cases of seminal vesicle cysts had been reported, as most were published after the introduction of ultrasound, CT and MRI. The majority of seminal vesicle cysts occur in young patients, and the main symptoms are hemospermia, perineal pain, pain during ejaculation, pelvic pain, dysuria, increased urinary frequency, recurrent pros-

FIG. 2. MRI confirms left seminal vesicle cyst 498

LAPAROSCOPIC EXCISION OF SEMINAL VESICLE CYSTS 499

REFERENCES tatitis and epididymitis, urinary infection and infertility. In 1 study MRI revealed seminal vesicle cysts in 13 of 15 hemo- spermia cases (86%).

In 1993 Kavoussi et a1 described the principles of laparo- scopic surgery on normal seminal vesicles in patients with prostate cancer’3 To Our there have been no re- ports in the literature on video laparoscopic excision of sem- inal vesicle cysts in children. Although video laparoscopy is still a new technique, it is considered an alternative approach to treat most seminal vesicles as well as other retrovesical diseases. The technique is less invasive and shows satisfac- tory preliminary results. 150: 417,1993.

1. Carmignani, G., Gallucci, M., Puppo, P., De Stefani, S., Simonato, A. and Maffezini, M.: Video laparoscopic excision of a seminal vesicle cyst associated with ipsilateral renal agene- sis. J . Urol., 153 437, 1995.

2. Williams, R. D.: Surgery of the seminal vesicles. In: P. C. Walsh, A. B. Retik, T. A. Stamey and E. D. Vaughan, Jr . : Campbell’s Urology. Philadelphia: W. B. Saunders Co., pp. 2942-2956, 1992.

3. Kavoussi, L. R., Schuessler, W. W., Vancaillie, T. and Clayman, R. V.: Laparoscopic approach to the seminal vesicles. J . Urol.,