"Semen-oma": Sequestered Semen Collection From Urethral Stricture and Bladder Neck Closure in Exstrophy...

Ejaculatory dysfunction in adult males with bladder exstrophy-epispadias complex can occur from associated genitourinary anomalies, surgical iatrogenic scarring, infection, obstruction, and neurologic and functional causes. This case presents a 30-year-old male patient with a history of bladder exstrophy reconstruction (bladder neck closure and appendicovesicostomy) who presented with a nine-year history of intermittent perineal scrotal pain, swelling, and intermittent urethral discharge. He presented with a tender palpable perineal mass ("semen-oma"). Examination under anesthesia and endoscopy of the urethra demonstrated a distal anterior penile and proximal urethral stricture at the level of the bladder neck level from previous surgical exstrophy reconstructive procedures. Aspiration of the mass revealed a thick viscous fluid suggestive of semen. Intraoperative endoscopic evaluation and radiographic imaging revealed a distal penile urethra stricture and proximal bladder neck closure from previous genitourinary reconstruction with sequestration of semen in the ectatic urethra with reflux into the seminal vesicle. A proximal ventral penile urethrostomy was performed to allow for permanent drainage of the sequestered semen collection and future antegrade ejaculation. The postoperative course was uneventful. This case highlights the potential for sexual ejaculatory dysfunction and the need for long-term and transitional urologic care in patients with a history of complex exstrophy reconstruction.