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Case 267.

Marcin Czarniecki1, Tristan Barrett1, Nikesh Thiruchelvam1

  • 1From the Departments of Radiology (M.C., T.B.) and Urology (N.T., O.W.), Addenbrooke's Hospital and the University of Cambridge, Cambridge, England.

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|February 22, 2019
PubMed
Summary
This summary is machine-generated.

A 28-year-old man with lifelong anejaculation was diagnosed with an intravesicular mass. This finding, revealed by MRI and cystoscopy, offers a potential explanation for his condition and aids in family planning discussions.

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Area of Science:

  • Urology
  • Radiology
  • Reproductive Medicine

Background:

  • Anejaculation, the absence of ejaculation, can significantly impact male fertility and family planning.
  • Lifelong anejaculation in a patient with normal erections and orgasm sensation necessitates thorough investigation for underlying causes.

Purpose of the Study:

  • To investigate the cause of lifelong anejaculation in a 28-year-old male patient.
  • To identify any anatomical or pathological factors contributing to the anejaculatory condition.

Main Methods:

  • The patient underwent a comprehensive diagnostic workup including physical examination, urine cytology for retrograde ejaculation, genetic testing for Y chromosome microdeletions, and hormonal assays (FSH, LH, testosterone).
  • Advanced imaging techniques, including pelvic MRI with dynamic contrast-enhanced study and CT urogram, were employed to evaluate pelvic anatomy.
  • Cystoscopy was performed to directly visualize the intravesicular and urethral structures.

Main Results:

  • Physical examination and initial tests for retrograde ejaculation and Y chromosome microdeletions were unremarkable.
  • Hormonal evaluation revealed normal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, with borderline low testosterone.
  • Pelvic MRI and CT urogram did not reveal significant abnormalities, but cystoscopy identified an intravesicular fluid-filled mass near the left ureteric orifice.

Conclusions:

  • The presence of an intravesicular mass identified during cystoscopy is a significant finding in a patient with lifelong anejaculation.
  • This mass represents a potential, previously undiagnosed, anatomical cause for the patient's anejaculation.
  • Further evaluation and management of the intravesicular mass are indicated to address the patient's fertility concerns.