The feasibility and experience of using seminal vesiculoscopy in the diagnosis of primary seminal vesicle tumors

With regard to using this technique for diagnosing seminal vesicle tumors, several technical skills are worth noting. Firstly, the orifice to the verumontanum or seminal vesicle could occasionally not be found. As illustrated in Figure 1a, it was not possible to locate the orifice of the verumontanum when the seminal vesicle tumor had invaded the urethra, but it was easy to obtain tumor tissue in such a situation. Secondly, once the ureteroscope was inserted into the lumen of the verumontanum, it was usually occupied with neoplasms that had migrated to the lumen from the unilateral seminal vesicle (Figure 1b). Therefore, it was extremely difficult to puncture the seminal vesicle with the head of Zebra guidewire because the normal anatomic structure had changed considerably, and space for maneuvering was extremely limited. In fact, it was not necessary to try to puncture the seminal vesicle when sufficient tumor tissue could be obtained for pathological evaluation (Figure 1c). The duration of operations involving seminal vesiculoscopy was between 15 and 25 min, and in all patients sufficient tumor tissue was obtained for pathologic evaluation (Table 1). There were no intraoperative or postoperative complications. After pathological confirmation of a malignant seminal vesicle tumor, all of the patients underwent open cystoprostatico-vesiculectomy with pelvic lymph node dissection and urinary diversion. The four patients in our study did not receive chemotherapy, radiotherapy or anti-androgenic therapy after surgery. The pathological results of the seminal vesiculoscopy biopsy were confirmed by the gross pathology. The advent of advanced imaging technology, for example TURS, MRI and computed tomography (CT), has improved sensitivity regarding the detection of abnormalities of the seminal vesicles; however, these imaging modalities have limited specificity concerning the differentiation of prostate cancer and primary tumors of the seminal vesicle. 6 In the present study, using all of the various examination techniques such as TRUS, CT and MRI the seminal vesicle masses were suspected as originating from prostate cancer; this was because prostate cancer is a common malignant disease in elderly patients and the imaging characteristics are difficult for radiologists to differentiate. Transrectal needle biopsy with TRUS guidance is an important approach in the differentiation of such unknown seminal vesicle masses. However, false negative results from transrectal needle biopsies are a serious concern. It should be noted that nearly 45% of patients have been reported to require exploration of the small pelvis Dear Editor, Primary tumors of the seminal vesicle are …