Seminal vesiculitis

Radiopaedia • CC-by-nc-sa 3.0 • de

Seminal vesiculitis is an uncommon entity characterized by inflammation of the seminal vesicles. It is most commonly infective in etiology and often associated with concurrent infection elsewhere in the male genital tract, forming part of the spectrum of male accessory gland inflammation . It is usually acute, although a chronic form is well-recognized .

Epidemiology

There is a lack of good data on the incidence and prevalence of seminal vesiculitis. However, one small study demonstrated that it was found in almost 25% of patients with synchronous urethritis .

Risk factors

Clinical presentation

The spectrum of symptomatology of seminal vesiculitis is broad:

  • ejaculatory dysfunction
    • painful ejaculation (odynorgasmia)
    • seminal hyperviscosity
    • decreased ejaculate volume
    • hematospermia
  • infertility
  • pain
    • pelvic
    • flank
    • abdominal
    • groin
  • abdominal swelling
  • hematuria
  • pneumaturia

Physical examination of the seminal vesicles is difficult due to their location, and even on digital rectal examination (DRE), with a long index finger, it can be technically-challenging to palpate the glands, especially if the bladder is distended.

Laboratory analysis:

  • urinalysis
    • hematuria
    • pneumaturia
    • infection (e.g. leukocytes, nitrites, etc.)
  • seminal fluid analysis may show
    • hematospermia
    • oligospermia/azoospermia
    • seminal hyperviscosity
    • decreased ejaculate volume

Pathology

The pathogenesis of seminal vesiculitis remains confused, with an unclear relationship between it and other infective conditions of the male excurrent ductal system, e.g. chronic prostatitis, urethritis, acute epididymitis.

Thus organisms that cause/contribute to these infective entities are also thought to play a role in vesiculitis, e.g. Chlamydia trachomatis

In relevant endemic regions, tuberculosis and schistosomiasis may both produce a chronic form of vesiculitis .

Radiographic features

TRUS/CT/MRI
  • diffuse mural thickening of the seminal vesicles
  • acute disease: dilatation of the seminal vesicular tubules
  • chronic disease: atrophy of the seminal vesicular tubules
  • CT/MRI
    • diffuse enhancement of the walls or septa

Treatment and prognosis

Acute seminal vesiculitis may respond to antibiotics. Chronic vesiculitis can be much more tricky to treat.

There is a risk of untreated/undertreated seminal vesiculitis progressing to a seminal vesicle abscess.