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Retrograde Ejaculation Owing to Ectopic Erectile Tissue
0022-534 7/88/1391-0592$02.00/0
Vol. 139, March Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1988 by The Williams & Wilkins Co.
RETROGRADE EJACULATION OWING TO ECTOPIC ERECTILE TISSUE J. R. STRACHAN, J. M. HEATON
AND
J. P. PRYOR
From the Institute of Urology, St. Peter's Hospitals and King's College Hospital, London, England
ABSTRACT
We report a case of retrograde ejaculation caused by ectopic erectile tissue in the posterior urethra. Transurethral resection of the tissue resulted in antegrade ejaculation. (J. Ural., 139: 592-593, 1988) To our knowledge retrograde ejaculation owing to a posterior urethral polyp has not been reported previously. We report such a case, which was associated with unilateral failure in the development of the mesonephric duct.
DISCUSSION
Our patient had an abnormality of the mesonephric duct system. Unilateral absence of the kidney occurs in about 1 of 550 people 2 and it is not infrequently associated with an ipsilateral abnormality of the vas. 3 Unilateral failure of mesonephric duct development often is characterized by an absent kidney and ureter, and vas aplasia. This condition sometimes is associated with a cyst of the seminal vesicle. The absence of the kidney and ureter with a distal vas deferens is more difficult to explain. However, it appears that the abnormality arose at the
CASE REPORT
M. H., a 20-year-old man, presented with an 18-month history of failure to ejaculate. Retrograde ejaculation was confirmed by the presence of immotile spermatozoa in a specimen of post-orgasmic urine. Urethroscopy revealed a small mass arising between the verumontanum and the bladder neck, which protruded into the bladder. The surface of this mass had the appearance of leukoplakia. No ureteral orifice was seen on the left side. The scrotal contents were normal. On bilateral vasograms the left vas ended blindly in the pelvis (fig. 1), while
FIG. 2. Cystogram with filling defect of posterior urethra
FIG. 1. Line drawing of vasogram shows left vas ending blindly in pelvis.
the right vas was associated normally with a seminal vesicle. Absence of the left kidney was confirmed by excretory urography, ultrasound and computerized tomography. A cystogram demonstrated the mass (fig. 2) and it was resected. Postoperatively, the patient regained antegrade ejaculation and, subsequently, he has fathered a child. Histologically, the urethral mass consisted of fibromuscular tissue, prostatic acini and vascular tissue with the characteristic features of erectile tissue (fig. 3). The surface layer contained transitional epithelium and a small focus of nonkeratinizing squamous metaplasia. No dysplasia was noted. The patient is examined annually because of the risk of dysplasia developing in areas of squamous metaplasia. 1 There has been no clinical recurrence of the metaplasia in 6 years. FIG. 3. Resected urethral polyp. Prostatic acini are surrounded by erectile tissue. H & E, reduced from XlO.
Accepted for publication July 8, 1987. 592
RETROGRADE EJACULATION OWING TO ECTOPIC ERECTILE TISSUE
time of separation of the ureteral bud from the vas, which would explain the absent ureteral orifice and would suggest an acquired rather than a congenital condition. In male subjects the paramesonephric (miillerian) duct shrinks to form the prostatic utricle, and persistence may give rise to a hamartomatous polyp of the posterior urethra.4 These masses are rare, with only 63 reported cases of which 9 were vascular. Our patient presented with retrograde ejaculation that was caused by ectopic erectile tissue and transurethral resection enabled him to father a child.
593
REFERENCES 1. Benson, R. C., Jr., Swanson, S. K. and Farrow, G. M.: Relationship
ofleukoplakia to urothelial malignancy. J. Urol., 131: 507, 1984. 2. Williams, P. L. and Warwick, R.: Gray's Anatomy, 36th ed. New York: Churchill Livingstone, pp. 210-222, 1980. 3. Deane, A. M. and May, R. E.: Absent vas deferens in association with renal abnormalities. Brit. J. Urol., 54: 298, 1982. 4. Kearney, G. P., Lebowitz, R. L. and Retik, A. B.: Obstructing polyps of the posterior urethra in boys: embryology and management. J. Urol., 122: 802, 1979.
Vol. 139, March Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1988 by The Williams & Wilkins Co.
RETROGRADE EJACULATION OWING TO ECTOPIC ERECTILE TISSUE J. R. STRACHAN, J. M. HEATON
AND
J. P. PRYOR
From the Institute of Urology, St. Peter's Hospitals and King's College Hospital, London, England
ABSTRACT
We report a case of retrograde ejaculation caused by ectopic erectile tissue in the posterior urethra. Transurethral resection of the tissue resulted in antegrade ejaculation. (J. Ural., 139: 592-593, 1988) To our knowledge retrograde ejaculation owing to a posterior urethral polyp has not been reported previously. We report such a case, which was associated with unilateral failure in the development of the mesonephric duct.
DISCUSSION
Our patient had an abnormality of the mesonephric duct system. Unilateral absence of the kidney occurs in about 1 of 550 people 2 and it is not infrequently associated with an ipsilateral abnormality of the vas. 3 Unilateral failure of mesonephric duct development often is characterized by an absent kidney and ureter, and vas aplasia. This condition sometimes is associated with a cyst of the seminal vesicle. The absence of the kidney and ureter with a distal vas deferens is more difficult to explain. However, it appears that the abnormality arose at the
CASE REPORT
M. H., a 20-year-old man, presented with an 18-month history of failure to ejaculate. Retrograde ejaculation was confirmed by the presence of immotile spermatozoa in a specimen of post-orgasmic urine. Urethroscopy revealed a small mass arising between the verumontanum and the bladder neck, which protruded into the bladder. The surface of this mass had the appearance of leukoplakia. No ureteral orifice was seen on the left side. The scrotal contents were normal. On bilateral vasograms the left vas ended blindly in the pelvis (fig. 1), while
FIG. 2. Cystogram with filling defect of posterior urethra
FIG. 1. Line drawing of vasogram shows left vas ending blindly in pelvis.
the right vas was associated normally with a seminal vesicle. Absence of the left kidney was confirmed by excretory urography, ultrasound and computerized tomography. A cystogram demonstrated the mass (fig. 2) and it was resected. Postoperatively, the patient regained antegrade ejaculation and, subsequently, he has fathered a child. Histologically, the urethral mass consisted of fibromuscular tissue, prostatic acini and vascular tissue with the characteristic features of erectile tissue (fig. 3). The surface layer contained transitional epithelium and a small focus of nonkeratinizing squamous metaplasia. No dysplasia was noted. The patient is examined annually because of the risk of dysplasia developing in areas of squamous metaplasia. 1 There has been no clinical recurrence of the metaplasia in 6 years. FIG. 3. Resected urethral polyp. Prostatic acini are surrounded by erectile tissue. H & E, reduced from XlO.
Accepted for publication July 8, 1987. 592
RETROGRADE EJACULATION OWING TO ECTOPIC ERECTILE TISSUE
time of separation of the ureteral bud from the vas, which would explain the absent ureteral orifice and would suggest an acquired rather than a congenital condition. In male subjects the paramesonephric (miillerian) duct shrinks to form the prostatic utricle, and persistence may give rise to a hamartomatous polyp of the posterior urethra.4 These masses are rare, with only 63 reported cases of which 9 were vascular. Our patient presented with retrograde ejaculation that was caused by ectopic erectile tissue and transurethral resection enabled him to father a child.
593
REFERENCES 1. Benson, R. C., Jr., Swanson, S. K. and Farrow, G. M.: Relationship
ofleukoplakia to urothelial malignancy. J. Urol., 131: 507, 1984. 2. Williams, P. L. and Warwick, R.: Gray's Anatomy, 36th ed. New York: Churchill Livingstone, pp. 210-222, 1980. 3. Deane, A. M. and May, R. E.: Absent vas deferens in association with renal abnormalities. Brit. J. Urol., 54: 298, 1982. 4. Kearney, G. P., Lebowitz, R. L. and Retik, A. B.: Obstructing polyps of the posterior urethra in boys: embryology and management. J. Urol., 122: 802, 1979.