ejaculatory pain as a result of inflatable penile prosthesis reservoir compressing a seminal vesicle

EJACULATORY PAIN AS A RESULT OF INFLATABLE PENILE PROSTHESIS RESERVOIR COMPRESSING A SEMINAL VESICLE VINEET AGRAWAL, DAVID RICKARDS, AND DAVID JOHN RALPH A 23-year-old man was referred for revision of his inﬂatable penile prosthesis. One cylinder had been removed after erosion through the glans; the other was too short. His second complaint was of severe long-standing postejaculatory pain that had been extensively investigated, including magnetic resonance imaging of his pelvis. This showed the reservoir of the prosthesis compressing the left seminal vesicle (Figs. 1 and 2). Obstruction was conﬁrmed by pre and postejaculatory transrectal ultrasound scans showing no change in the seminal vesicle parameters. Unaware of the previous history of a penile prosthesis, the “large midline mullerian duct cyst” was accidentally aspirated. This resulted in permanent and immediate resolu- tion of the patient’s ejaculatory pain but mechani- cal failure of the prosthesis. The whole device was exchanged using a single 15-cm AMS CX 700 cylinder. The old reservoir was left in situ with the replacement put in the right iliac fossa. The patient was able to have satisfactory sexual intercourse without ejaculatory pain. COMMENT Compression of the seminal vesicles, either congenitally 1 or by a reservoir, can result in postejaculatory pain. Radiologists should be in- formed of this possibility to prevent misinterpre- tation of a mullerian duct cyst, which can be diagnostically aspirated. REFERENCE 1. Stricker HJ, Kunin JR, and Faerber GJ: Congenital pros- tatic cyst causing ejaculatory duct obstruction: management by transrectal cyst aspiration. J Urol 149: 1141–1143, 1993. From the Institute of Urology; and Department of Radiology, Uni- versity College London Hospitals NHS Foundation Trust, Lon- don, United Kingdom Reprint requests: Vineet Agrawal, M.R.C.S.Ed., Institute of Urol- ogy, 47 Riding House Street, London W1W 7EY, United Kingdom. E-mail: [email protected] Submitted: January 22, 2006, accepted (with revisions): May 1, 2006 FIGURE 2. Sagittal section of magnetic resonance image. A reservoir; B left seminal vesicle; C single penile cylinder. FIGURE 1. Transverse section of magnetic resonance image. A reservoir; B left seminal vesicle; C right seminal vesicle. IMAGES IN CLINICAL UROLOGY © 2006 ELSEVIER INC. UROLOGY 68: 888, 2006 • 0090-4295/06/$32.00 888 ALL RIGHTS RESERVED doi:10.1016/j.urology.2006.05.002

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Page 1: Ejaculatory pain as a result of inflatable penile prosthesis reservoir compressing a seminal vesicle

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IMAGES IN CLINICAL UROLOGY

EJACULATORY PAIN AS A RESULT OF INFLATABLE PENILEPROSTHESIS RESERVOIR COMPRESSING A SEMINAL VESICLE

VINEET AGRAWAL, DAVID RICKARDS, AND DAVID JOHN RALPH

Fapenile cylinder.

Fiseminal vesicle.

23-year-old man was referred for revision ofhis inflatable penile prosthesis. One cylinder

ad been removed after erosion through the glans;he other was too short. His second complaint wasf severe long-standing postejaculatory pain thatad been extensively investigated, including mag-etic resonance imaging of his pelvis. This showedhe reservoir of the prosthesis compressing the lefteminal vesicle (Figs. 1 and 2). Obstruction wasonfirmed by pre and postejaculatory transrectalltrasound scans showing no change in the semi-al vesicle parameters. Unaware of the previousistory of a penile prosthesis, the “large midlineullerian duct cyst” was accidentally aspirated.his resulted in permanent and immediate resolu-

ion of the patient’s ejaculatory pain but mechani-al failure of the prosthesis. The whole device wasxchanged using a single 15-cm AMS CX 700 cyl-nder. The old reservoir was left in situ with theeplacement put in the right iliac fossa. The patientas able to have satisfactory sexual intercourseithout ejaculatory pain.

COMMENT

Compression of the seminal vesicles, eitherongenitally1 or by a reservoir, can result inostejaculatory pain. Radiologists should be in-ormed of this possibility to prevent misinterpre-ation of a mullerian duct cyst, which can beiagnostically aspirated.

REFERENCE1. Stricker HJ, Kunin JR, and Faerber GJ: Congenital pros-

atic cyst causing ejaculatory duct obstruction: managementy transrectal cyst aspiration. J Urol 149: 1141–1143, 1993.

rom the Institute of Urology; and Department of Radiology, Uni-ersity College London Hospitals NHS Foundation Trust, Lon-on, United Kingdom

Reprint requests: Vineet Agrawal, M.R.C.S.Ed., Institute of Urol-gy, 47 Riding House Street, London W1W 7EY, United Kingdom.-mail: [email protected]: January 22, 2006, accepted (with revisions): May

, 2006

IGURE 2. Sagittal section of magnetic resonance im-ge. A � reservoir; B � left seminal vesicle; C � single

IGURE 1. Transverse section of magnetic resonancemage. A � reservoir; B � left seminal vesicle; C � right

UROLOGY 68: 888, 2006 • 0090-4295/06/$32.00doi:10.1016/j.urology.2006.05.002

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