Seminal vesicle stones or calculi refer to solid mineralized pieces of material within the seminal vesicles.
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Epidemiology
Seminal vesicle calculi are rare and have been mainly reported after the age of 40 years 1.
Associations
Seminal vesicle calculi are often associated with hematospermia.
Diagnosis
The diagnosis of seminal vesicle stones can be conveniently made by typical imaging features on transrectal ultrasound (TRUS), CT or MRI 1,2. They might be also diagnosed on a pathological specimen.
Clinical presentation
Clinically seminal vesicle stones can present with hematospermia, hematuria, dysuria pelvic, perineal, testicular or ejaculatory pain and rarely spermolithiasis 1-4.
Pathology
Seminal vesicle stones can consist of the following 3:
proteinaceous material
carbonate apatite
calcium oxalate
calcium fluorophosphate
Etiology
The exact etiology of seminal vesicle stones seems to be unclear, possible etiological factors include the following 1,2:
diverse inflammatory or infectious processes e.g. seminal vesiculitis
ejaculatory duct obstruction and neoplasms
congenital anomalies
Radiographic features
Seminal vesicle stones are visible on different imaging methods including transrectal ultrasound (TRUS), CT and MRI as well-defined, intraluminal structures within the seminal vesicles 1,2. They might be calcified or non-calcified.
Ultrasound
On transrectal ultrasound (TRUS) seminal vesicle stones have been described as well-circumscribed hyperechoic foci with or without acoustic shadowing that can be distinguished from the typical architecture of the seminal vesicles 1.
CT
Computed tomography is able to depict seminal vesicle calculi within the seminal vesicle lumen in different planes and is especially useful if they are calcified.
MRI
On prostate or pelvic MRI, seminal vesicle stones can be visualized as polygonal intraluminal structures surrounded by seminal fluid or associated with hematospermia 2,4.
Signal characteristics
T2: hypointense
DWI: lack of diffusion restriction
DCE (Gd): no enhancement
Radiology report
The radiological report should include a description of the following:
location form and extent of intraluminal stones
seminal vesicle hemorrhage
associated findings and etiologies e.g. ejaculatory duct obstruction or prostate cancer
Treatment and prognosis
Management of seminal vesicle calculi includes surgical intervention for stone removal. Different surgical approaches include transurethral resection of ejaculatory ducts (TURED), transurethral seminal vesiculoscopy (TRU-SVS) endoscope laser lithotripsy, laparoscopic, robot-assisted and open approaches 1,2,4.
History and etymology
The first case report of seminal vesicle stones was made by White in 1928 1.
Differential diagnosis
Conditions that may be mimicking the clinical presentation or imaging appearance of seminal vesicle calculi include 1:
seminal vesicle calcification
ejaculatory duct calcification