[Quiz]: Recurrent prostatitis, ejaculatory pain in 34-year-old male

Figure 1.

A 34-year-old male has a known left atrophic kidney. He has been suffering from recurrent bouts of prostatitis and ejaculatory pain radiating to his left flank. He was also found to have oligospermia on a previous workup for infertility. A magnetic resonance imaging scan was obtained to evaluate the patient’s anatomy (figure 1).

Continue to the next page for the answer.

Answer

D. Left ectopic ureter

Figure 2.

Discussion

The patient’s symptoms can be explained by a left ectopic ureter inserting into the ipsilateral seminal vesicle (figure 2), thus giving it a prominent appearance on the previous figure as well as an atrophic right seminal vesicle. Embryologically, the abnormality can be explained by a ureteric bud that originated more cephalad on the mesonephric duct causing it to open into structures which the duct differentiates to such as the posterior urethra, ejaculatory duct, seminal vesicles, and vas deferens. Incontinence is not seen as these structures are proximal to the membranous urethral sphincter. The more cephalic origin of the ureteric bud also explains the renal dysplasia since the bud will not meet the nephrogenic cord in the proper orientation. Surgical excision in the form of left nephroureterectomy with seminal vesiculectomy is the most appropriate treatment in this case.

Suggested reading

Ureteral ectopia presenting as epididymitis and infertility. Urology 1987; 30:67-9.

Dr. Sorokin, endourology fellow at the University of Texas Southwestern Medical Center, Dallas, is section editor for Urology Times Clinical Quiz.