CONGENITAL SEMINAL VESICLE CYST AND COEXISTING RENAL AGENESIS: LAPAROSCOPIC APPROACH EVANGELOS N. LIATSIKOS, BENJAMIN LEE, KRITON S. FILOS, AND GEORGE A. BARBALIAS ABSTRACT We report a case of laparoscopic excision of a large symptomatic left seminal vesicle cyst and ipsilateral renal agenesis. A 26-year-old man presented with a 15-year history of dysuria and irritative voiding symptoms. The diagnostic evaluation revealed a 62  40  35-mm left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with no evidence of the left renal unit. Transperitoneal laparoscopic excision of the cyst was performed successfully. The total operative time was 190 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day and did not present with any complaints or complications thereafter. UROLOGY 63: 584.e12–584.e14, 2004. © 2004 Elsevier Inc. M ost seminal vesicle cysts are congenital, and two thirds are associated with renal dysplasia or agenesis and/or an ectopic ureter opening into the seminal vesicle. We report a case of laparo- scopic decortication of a left seminal vesicle cyst in a young patient with concomitant ipsilateral renal agenesis. CASE REPORT A 26-year-old man presented with a 15-year his- tory of dysuria, irritative voiding symptoms, recur- rent gram-negative urinary tract infection, and ep- ididymitis. Digital rectal examination revealed a large cystic mass in the prostate region with no definable limits. Physical examination showed normal bilateral testes and vas deferens. Ultra- sonography revealed a 62  40  35-mm left sem- inal vesicle cyst (Fig. 1A), which was confirmed on computed tomography (Fig. 1B). In addition, the patient had a solitary, right, functioning kidney, with no evidence of the left renal unit. Retrograde cystourethrography depicted the presence of a noncontrast-enhancing defect of the left postero- lateral surface of the bladder (Fig. 1C). Cysto- scopic evaluation revealed a normal right ureteral orifice; no evidence of a left ureteral orifice or blad- der diverticulum was found. The ipsilateral hemi- trigone was not developed. One year before the final operative procedure, transrectal aspiration of the cyst fluid was performed successfully and sent for culture, biochemical testing, and cytology. Contrast agent was injected through the aspiration site to document the final diagnosis. The aspirated fluid did not contain urine, was sterile, and was full of sperm cells. The cyst recurred 2 months after the initial aspiration. Transperitoneal laparoscopic excision of the cyst was then performed successfully with the patient under general anesthesia. Four laparoscopic ports were used: a 10-mm port at the umbilicus, a 5-mm port in the middle in the proximity of the pubis, and a 5-mm and 12-mm port on the left and right sides lateral to the rectoabdominal muscles and a short distance below the umbilicus, respectively. The surgical table was placed in the Trendelen- burg position, the bladder was retracted anteriorly, and the cyst was easily identified by a transverse incision in the retrovesical peritoneum. The left vas deferens was identified and dissected medially to the ampulla and was used as a guide to the sem- inal vesicle. The dilated seminal vesicle was ini- tially punctured and emptied. It was then opened (Fig. 2) to facilitate dissection from the surround- ing structures. Finally, it was clipped and excised at the level of the ipsilateral ejaculatory duct. The entire cystic specimen was extracted through the 12-mm port. The total operative time was 190 minutes, and blood loss was minimal. The patient was dis- B. R. Lee has an unrestricted educational grant from U.S. Surgical. From the Departments of Urology and Anesthesiology, Univer- sity of Patras Medical School, Rion, Greece; and Department of Urology, Long Island Jewish Medical Center, Brooklyn, New York Address for correspondence: George A. Barbalias, M.D., De- partment of Urology, University Hospital, University of Patras Medical School, Rio, Patras 26500, Greece Submitted: July 28, 2003, accepted (with revisions): November 11, 2003 CASE REPORT © 2004 ELSEVIER INC. 0090-4295/04/$30.00 584.e12 ALL RIGHTS RESERVED doi:10.1016/j.urology.2003.11.019