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Communicating seminal vesicles leading to indirect vasal communication: A case report.

ABSTRACT: We are presenting a case of 42 year old male, suffering from secondary infertility. Nine years ago he developed bilateral scrotal pain followed by azoospermia and infertility. At our center during vasography we found that the dye was not seen in bladder or prostatic urethra. But interestingly a direct communication was observed between both seminal vesicles, and through that channel an indirect communication was observed between both vas deferens. It is suggested that the patient developed obstructive azoospermia as a sequel of epididymo-orchitis. It is also concluded that seminal vesicle communication was initially not a primary problem for patient's fertility.

SUBMITTER: Rehman KU

PROVIDER: S-EPMC7573756 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Communicating seminal vesicles leading to indirect vasal communication: A case report.

Rehman Khaleeq Ur KU Siddiqui Amjad Ali AA

Urology case reports 20200529

We are presenting a case of 42 year old male, suffering from secondary infertility. Nine years ago he developed bilateral scrotal pain followed by azoospermia and infertility. At our center during vasography we found that the dye was not seen in bladder or prostatic urethra. But interestingly a direct communication was observed between both seminal vesicles, and through that channel an indirect communication was observed between both vas deferens. It is suggested that the patient developed obstr ...[more]

PMID: 33101990

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Project description:We report a successful bilateral globus pallidus internus-deep brain stimulation (GPi-DBS) for a Parkinson disease (PD) patient with idiopathic normal pressure hydrocephalus (INPH) and an unusually long anterior commissure-posterior commissure (AC-PC) line. A 54-year-old man presented with a history of 3 months of severe shuffling gait, rigidity, slow movements of the left side limbs, and difficulty managing finances. A brain MRI revealed marked ventriculomegaly (Evans index = 0.42). The patient was diagnosed with INPH and a ventriculoperitoneal shunt was placed. Cognitive impairment improved, but walking disturbances, slowness, and rigidity persisted. Then treatment with levodopa was added, and the patient experienced a sustained improvement. He was diagnosed with PD. After 7 years, the patient developed gait freezing and severe levodopa-induced dyskinesia. The patient underwent bilateral GPi-DBS. We used MRI/CT fusion techniques for anatomical indirect targeting. Indirect targeting is based on standardized stereotactic atlas and on a formula-derived method based on AC-PC landmarks. The AC-PC line was 40 mm (the usual length is between 19 and 32 mm). Intraoperative microelectrode recording was a non-expendable test, but multiple recordings were avoided to reduce the surgical risk of ventricular involvement. There was a 71% decrease in the UPDRS III score during the on-stimulation state (28 to 8). The patient's dyskinesias resolved dramatically with a UdysRS of 15 (88% improvement) during the on-stimulation condition. The observed motor benefits and the improvement of his daily activities have persisted 6 months after surgery. Deep brain stimulation surgery in PD with ventriculomegaly is a challenge. This procedure can result in a greater chance of breaching the ventricle, with risks of intraventricular hemorrhage and migration of cerebrospinal fluid into the brain parenchyma with target displacement. Furthermore, clinical judgment is paramount when recent onset of shuffling gait coexists with ventriculomegaly because the most common dilemma is differentiating between PD and INPH. For these reasons, neurologists and surgeons may refuse to operate on PD patients with ventriculomegaly. However, DBS should be considered for PD patients with motor complications when responsiveness to levodopa is demonstrated, even in the context of marked ventriculomegaly.

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Communicating seminal vesicles leading to indirect vasal communication: A case report.

Publications

Communicating seminal vesicles leading to indirect vasal communication: A case report.

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