Urology/Stone in seminal vesicle
I'm 45yo and in the UK. I want to get some advice about a MRI scan of the prostate I had recently to investigate chronic prostatitis which showed a possible stone in the left seminal vesicle.
As a background, I didn't start sexual activity until 23yo but my semen has been lumpy since my mid-teens, with folded-up gelatinous strings 2-5cm in length. Since then I've always had symptoms that have always varied dependent on the viscosity of my semen, apart from 3 months of normality after a 5-day course of Ampicillin for a UTI at 20yo.
When my semen is very viscous (which has usually been the case in the last 10 years), my main complaint is markedly reduced pleasure with orgasms with reduced/minimal force to ejaculations, and erectile dysfunction including absence of spontaneous erections while awake. Every few months I would get a momentary shooting twinge in the prostate area, as if passing a stone. The twinge would be so brief and unexpected, I wouldn't recognise if it was to one side of the midline or not.
14 months ago, I got antibiotic treatment of the prostatitis, and in the past year the viscosity has often been reduced (watery, rather than the usual semi-solid) and the semen lumpiness has also diminished at times. Even though I see this as an improvement in the condition, subjectively it feels like a 'flare up' in that the symptoms I then get are more bothersome:
- ache/heaviness slightly to the left of the front of rectum,
- leakage of semen into the posterior urethra,
- urinary frequency and burning irritative feeling in the urethra near the prostate, in perineum or 1 inch below the tip of the penis,
- rectal tenesmus,
- occasional testicular ache,
- eruptions of acne-like spots on chest/back/upper arms,
- 6 or more episodes of being woken up by a rectal pain associated with a morning erection.
With watery semen, I do also get improvement in the symptoms I associate with viscous semen. I had a 5-day period, 2 weeks after finishing the antibiotics, when my semen was lump-free and very watery. With that I had a huge surge in libido with very frequent spontaneous 'normal' erections. However at the time I also had what I assume was spermatorrhoea, as I could often sense copious leakage of semen into the posterior urethra which I could feel pool there before making it's way out of my penis. This leakage also had an burning sensation in the posterior urethra that lessened gradually over 3-4 days. I also had one episode while masturbating of semen shooting out when I simply got up onto my feet - basically an episode of stress incontinence.
I have subsequently been referred to a Urologist and had a renal/bladder ultrasound (normal), MSU's (no growth), PSA (very slightly raised) and semen analysis (pH=8.3, gel bodies, viscous antisperm antibodies present.) Of note, I've never yet had an EPS attempted or a semen culture done.
In addition I had a cystoscopy ('high bladder neck') and prostate massage under GA. The massage didn't have much improvement on top of the benefit I'd already had from the antibiotics. I was told, based on this, that I didn't have chronic prostatitis and would be discharged from the Urologist's care.
As I disputed his opinion, he referred me to another Urologist in the same hospital for a second opinion. The 2nd Urologist was satisfied that I did have chronic prostatitis and arranged for a MRI of my prostate.
The MRI report confirmed evidence of Chronic Prostatitis but also noted a "1cm focus of very low T2 signal intensity within the seminal vesicle on the left side which could represent a calculus (the differential would include old blood or gas)". The report suggested a TRUS would be of use to further investigate the left seminal vesicle.
However, when I saw the Urologist for a second time he simply gave me some lifestyle advice, a copy of the MRI report and discharged me from his care. He didn't even question me about blood in my semen.
However, I've never seen any blood in my semen, apart from 13 years ago when I had an episode of brown semen. That episode was associate with a numb orgasm, but no fever, and with an absence of the usual semen lumps I get. I was diagnosed and treated then for Acute Prostatitis, although I wonder now if that was actually Seminal Vesiculitis.
I've since spoken to the radiologist who reported the MRI, and she was bemused that a TRUS wasn't being done and said they basically do MRI's for prostatitis just to pick up a rare significant finding like my scan found.
I have since been reading online about seminal vesiculitis and find I fit most of the symptoms, although I also feel there's not a great understanding out there about the condition today. In fact, I found the most useful articles about it are from 1921-46 (and even earlier), possibly because gonorrhoea etc appear to have been treated by urologists in those days. Judging by the predominance of veterinary results in a Google search, I actually suspect that a bull or stallion with seminal vesiculitis would get better attention than a man would.
I have in the past noticed improvements in my main complaint of reduced pleasure with orgasm with 2 thing. Frequent ejaculation helps. Also summer beach holidays help probably as my body would get heat up and then I'd cool down in the sea. Based on treatments I read about in an old article, for the past week I've tried daily warm rectal douches and these have helped with reducing viscosity and improving erectile dysfunction, though they've also increased the bothersome symptoms I get with watery semen. I plan to incorporate cold water rectal douches as well soon as they have been suggested to help improve the muscle tone of the ejaculatory ducts. Hopefully that might give me a similar improvement to what I get on beach holidays.
I am planning to see my family doctor soon and would like for a semen culture to be done. I'll also discuss with him being referred again to a Urologist (maybe even a Veterinarian!) for further investigation.
- Although I know I also have prostatitis, would you agree my history is suggestive more of seminal vesiculitis symptoms?
- Are seminal vesicle stones very rare?
- If it turns out to be a stone in the seminal vesicle, what methods are available to treat such a stone?
- Have you any knowledge/opinion about rectal douches, both warm and cold?
Your symptoms would appear to be most consistent with prostatitis. Seminal vesicle stones in humans are relatively rare. I would not normally recommend rectal douches for your problem, but I see little harm and they appear to be working.
Below is an article you may find interesting followed by my general guidelines on prostatitis.
Transurethral seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle stones.
Song T1, Zhang X, Zhang L, Zhang F, Fu WJ.
Author information 1Department of Urology, Clinical Division of Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China. firstname.lastname@example.org
BACKGROUND: Seminal vesicle stones are one of the main causes of persistent hemospermia. Treatment requires removal of the stone, generally through open vesiculectomy. The purpose of this study was to apply a transurethral seminal vesiculoscopy for diagnosis and treatment of the seminal vesicle stones with an ureteroscope. We assessed whether this transurethral endoscopic technique is feasible and effective in the diagnosis and treatment of the seminal vesicle stones with intractable hemospermia.
METHODS: Totally 12 patients with intractable hemospermia underwent transurethral seminal vesiculoscopy through the distal seminal tracts using a 7.3-French rigid ureteroscope. Age of patients ranged from 25 to 57 years (mean age (43.7 ± 10.5) years). The patients' symptoms ranged in duration from 4 to 180 months (mean duration (47.8 ± 45.3) months). All patients underwent transrectal ultrasonography, pelvic computed tomography or magnetic resonance imaging before the operation. Positive imaging findings were observed in patients with seminal vesicle stones and dilated seminal vesicle size. A 7.3-French rigid ureteroscope entered the lumen of the verumontanum, and then the seminal vesicle under direct vision. Seminal vesicle stones were found unilaterally in 11 cases and bilaterally in one case.
RESULTS: All 12 patients successfully underwent transurethral seminal vesiculoscopy. The seminal vesicle interior with single or multiple yellowish stones ranging from 1 to 5 mm in diameter was clearly visible. All the stones were easily fragmented and endoscopically removed using a grasper. The operative time was 30 to 120 minutes (mean (49 ± 22) minutes). The mean follow-up period was (6.9 ± 3.0) months (range 3-13 months). Symptoms of hemospermia disappeared after one month in 10 patients and after three months in two patients. Three patients with painful ejaculation could completely be relieved postoperation. There was also improvement in one patient with erectile dysfunction. There were no postoperative complications.
CONCLUSIONS: Transurethral seminal vesiculoscopy is safe and effective in the diagnosis and treatment of seminal vesicle stones. This endoscopic technique can be performed with minimal complications.
PMID:22613656[PubMed - indexed for MEDLINE]
Typical Treatments for Prostatitis Include:
Avoid caffeine which irritates the prostate and bladder.
Hot sitz baths. Sitting in a very hot tub for 10 minutes really seems to reduce pelvic pain, inflammation and discomfort. We recommend twice or even three times a day for severe cases or flare-ups, but at least once a day for most prostatitis patients.
Avoid hot spices which tend to irritate the prostate.
Avoid sitting on hard surface; use an inflatable donut to spread the pressure away from the prostate.
Use NSAIDs like ibuprofen (Motrin, Advil) or naprosyn (Aleve) to help reduce discomfort and inflammation.
Antibiotics as prescribed by your physician.
Alpha blocker medications such as tamsulosin and alfuzosin will help relax muscle tension in the prostate.
Avoid high potassium foods that some people are sensitive to and which can be irritating.
Less alcohol and smoking.
Use quercetin which is a natural anti-inflammatory herbal supplement that has been shown to help reduce inflammation in the prostate.