Seminal Vesiculitis: A Rare Cause of Unilateral Ureteric Obstruction

The seminal vesicles are an accessory structure of the male reproductive system. The most common pathology associated with the seminal vesicles is infective, and patients may present with haematospermia, pain, and subfertility. Patients presenting with unilateral ureteric obstruction secondary to seminal vesiculitis are rare, and there are very few reported cases in the literature. This case report aims to review the presentation and management of such a case. A 59-year-old male presented to the emergency department with right-sided abdominal pain, vomiting, haematuria, and reduced urinary output. Blood tests showed raised inflammatory markers, hyperkalaemia, and a significant acute kidney injury with a creatinine of 695 µmol/L and an estimated glomerular filtration rate (eGFR) of 7 from a normal baseline. Non-contrast computed tomography (NCCT) imaging of the renal tracts identified an atrophic left kidney and a large soft tissue lesion at the level of the distal third of the right ureter, concerning for a primary ureteric malignancy. Notably, urine samples sent for cytology were reported as negative for malignancy. Following drainage and recovery from the acute episode, a timely outpatient ureteroscopy revealed no abnormalities of the ureter, and a subsequent magnetic resonance imaging (MRI) concluded right-sided seminal vesiculitis as the cause of this patient's presentation. This case report demonstrates seminal vesiculitis as a rare cause of ureteric obstruction. It can mimic upper tract urothelial carcinoma (UTUC) and highlights the importance of a definitive diagnosis in patients with suspected upper renal tract transitional cell carcinoma.