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Case 267: Cecureterocoele Manifesting in a Man with Infertility
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.
Radiology
|June 21, 2019
Summary
A man with lifelong anejaculation, despite normal orgasms, was diagnosed with an intravesicular mass. This finding offers a potential explanation for his inability to ejaculate, aiding family planning efforts.
Area of Science:
- Urology
- Reproductive Medicine
- Medical Imaging
Background:
- Anejaculation, the absence of ejaculation, can significantly impact male fertility and family planning.
- This case highlights the diagnostic challenges in lifelong anejaculation.
- Normal sexual function with anorgasmia and anejaculation necessitates thorough investigation.
Observation:
- A 28-year-old male presented with lifelong anejaculation, normal erections, and orgasmic sensation without ejaculation.
- Physical examination revealed normal testes and epididymis, with a slightly tender left testicle.
- Initial investigations including urine cytology, genetic testing for Y chromosome microdeletions, and hormonal assays (FSH, LH, testosterone) were largely non-contributory, though testosterone was borderline low.
Findings:
- Pelvic MRI and CT scans were performed to rule out anatomical causes.
- Cystoscopy revealed an intravesicular fluid-filled mass adjacent to the left ureteric orifice.
- This mass is a potential cause of the patient's lifelong anejaculation.
Implications:
- The identification of an intravesicular mass provides a potential anatomical explanation for lifelong anejaculation.
- This finding is crucial for guiding further management and potential treatment options.
- Understanding such rare causes of anejaculation can improve diagnostic accuracy and patient counseling regarding fertility.
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