Ectopic ureter draning into enlarged seminal vesicle: echographic and CT findings

Clinical History

Patient with severe testicular pain and symptoms of urinary infection.

Imaging Findings

In April 2005, a 35 y.o. man was admitted to our hospital referring pelvic pain. Physical examination revealed severe testicular dolorability and enlarged epidydime. Other symptoms were piuria and dysuria. Was either reported prior history of testicle trauma. Laboratory examination data, including urine analysis and culture, evidenced abnormal values compatible with urinary infectious condition. Were performed trans-abdominal and trans-rectal sonographic examinations: ultrasounds showed right renal agenesis, with ectopic ureteral insertion draining into pelvic mass, referable, in first step, to enlarged seminal vesicle. For a better diagnostic evaluation was subsequently carried on a contrast enhanced CT scan. CT images confirmed the absence of right kidney and evidenced ipsilateral ectasic ureter draining into pelvic complex structure with high attenuation signal, (compatible with high protein concentration fluid) confirming ultrasonographic diagnosis of renal agenesis with ectopic ureter insertion draining into seminal vesicle.

Discussion

Ectopic ureter draining in enlarged seminal vesicles is a rare condition often associated with renal dysplasia or agenesis. Usually this malformation becomes apparent in the second or third decade during the period of maximal sexual and reproductive activity. In most of cases is an asymptomatic condition and no specific disturbs are reported. Diagnosis is incidental during imaging examination carried on for different causes. In cases where a symptomatology is present, it results often related to bladder infection. The incidence of this pathology is about 0.025% of the population, is more frequent in females than in males (f/m ratio=6:1) and approximately 10% of cases are bilateral. In females, more than 80% of ectopic ureters drain duplicated systems, whereas in males ectopic ureters drain most a single system. Approximately 80% of all ectopic ureters drain the upper pole of a duplex kidney. Ectopic insertion of the ureter stems from abnormal ureteral bud migration and usually results in caudal ectopia. Normally, the primitive ureteral bud travels cephalad, whereas the mesonephric duct, from which it originates, travels caudad: if the ureteral bud fails to separate from the mesonephric duct, it may be carried into a more caudal position than normal. Consequently, the opening of the ureter becomes caudally ectopic and in male inserts in one of the structures originated from the mesonephric duct (prostatic urethra 48%, seminal vesicles 40%,ejaculatory duct 8% , vas deferens 3%), like in our case. In females, the ureters may terminate in bladder neck/urethra (35%), vestibule (30%), vagina (25%), or uterus (5%). The most frequently encountered anomaly associated with ectopic ureter is hypoplasia or dysplasia of renal moiety.In our case we reported an ectopic ureter draining into enlarged seminal vesicle with absence of the ipsilateral kidney, a very uncommon condition with fewer than 100 cases reported in literature. Several imaging techniques have been used in the evaluation of these malformations. Intravenous urography can demonstrate ipsilateral renal agenesis and an abnormal appearance of the collecting systems. Ultrasounds usually allow exclusion of a duplex kidney and of obstruction due to a ureterocele; it delineates the abnormal fluid-filled ureter in most cases and allows the ureter to be traced into the pelvis and into an abnormally low position beyond the bladder. The upper moiety may be too small to be detected, and the diagnosis may depend on recognizing the absence of an upper pole caliceal group or apparent excessive thickness of the renal tissue on the medial aspect of the upper pole. CT examination reveals renal anomalies and defines pelvic anatomy; it’s necessary for a definitive diagnosis and may be useful on occasion in locating a small, poorly functioning dysplastic kidney.Invasive examinations as cystography or seminal vesiculography can be helpful in the confirmative diagnosis of ectopic ureter.

Differential Diagnosis List

Final Diagnosis

Ectopic ureter draining into seminal vesicle

URL:	https://www.eurorad.org/case/3972
DOI:	10.1594/EURORAD/CASE.3972
ISSN:	1563-4086