Ejaculatory duct cyst mimicking post-TURP ejaculatory dysfunction - A diagnostic challenge in a patient with hemospermia and hypospermia

Sep 30, 2026

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Ejaculatory duct cysts are uncommon urological entities that may be difficult to diagnose after prostate surgery. A 60-year-old man underwent TURP for a 65 g prostate and developed hemospermia and hypospermia six months later. Pelvic MRI identified a 12 mm cyst in the ejaculatory duct region above the verumontanum, confirmed by cystoscopy. Semen analysis showed oligoasthenospermia, with post-ejaculatory urine lacking spermatozoa. Conservative surveillance was chosen and follow-up improved hemospermia while hypospermia persisted.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Case presentation

Diagnostic workup

Management and follow-up

Urology Case Reports 64 (2026) 103316 Contents lists available at ScienceDirect Urology Case Reports journal [homepage:](homepage: www.elsevier.com/locate/eucr)[ www.elsevier.com/locate/eucr](homepage: www.elsevier.com/locate/eucr) | Andrology and fertility
Ejaculatory duct cyst mimicking post-TURP ejaculatory dysfunction: A diagnostic challenge in a patient with hemospermia and hypospermia | | | | --- | --- | --- | | *
Youssef Maachi , Youssef Bentalb , Amine Zaki , Amine Slaoui , Tariq Karmouni , Abdellatif Koutani , Khalid Elkhader
Department of Urology B, CHU Ibn Sina, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco | | | | A R T I C L E I N F O
Keywords:
Ejaculatory duct cyst TURP complications Conservative management Male infertility | A B S T R A C T | | | | Ejaculatory duct cysts are uncommon urological entities that can be difficult to diagnose after prostate surgery. We report a 60-year-old man who underwent TURP for a 65 g prostate and developed hemospermia and hypospermia six months later. Pelvic MRI identified a 12 mm cyst in the ejaculatory duct region above the verumontanum, confirmed cystoscopically. Post-ejaculatory urine contained no spermatozoa, while semen analysis showed oligoasthenospermia (8 million/mL, 15 % progressive motility, volume 0.8 mL). In view of the small cyst, partial preservation of ejaculation, patient age, and completed family planning, conservative surveillance was chosen. At six months, hemospermia regressed but hypospermia persisted. | | 1. Introduction Ejaculatory duct cysts are rare urological conditions that pose diagnostic challenges, especially in patients with prior prostate surgery. These midline pelvic cysts arise from embryological remnants and may present from asymptomatic findings to significant reproductive complications.1,2 Due to increased MRI use for genitourinary pathologies, male pelvic cysts are now detected more frequently.3 EDO represents around 5 % of all male-factor infertility cases and is either congenital or acquired in origin 4. The congenital causes include Wolffian and Müllerian duct anomalies, though acquired causes are due to inflammation, trauma, iatrogenic injury, as well as cystic lesions.5 The classification of midline pelvic cysts is based on origin: Müllerian duct cysts, seminal vesicle cysts, ejaculatory duct cysts, and prostatic cysts.6 Post-TURP ejaculatory dysfunction, including retrograde ejaculation, reduced volume or anejaculation, occurs in 65–75 % of cases.7 These common sequelae may obscure underlying pathology such as ejaculatory duct cysts, which require high diagnostic suspicion with appropriate imaging and endoscopy. Clinical presentations include pelvic pain, recurrent UTIs, painful ejaculation, hemospermia, hypospermia, and infertility.8 Diagnosis involves semen analysis, TRUS, MRI, and cystoscopy. Treatment ranges from surveillance in small asymptomatic cysts to transurethral resection of ejaculatory ducts (TURED) for symptomatic lesions.9 We present the case of a small ejaculatory duct cyst in a 60-year-old man identified during the investigation of post-TURP hemospermia and hypospermia and discuss the diagnosis and management challenges. 2. Case presentation A 60-year-old married man with one daughter presented to our urology clinic with complaints of hemospermia and hypospermia. Nine months previously, he had TURP for a prostate weighing 65 g with successful relief of obstructive symptoms. Six months later, he also presented with complaints of blood-tinged semen and decreased ejaculatory volume which distressed him a lot. He denied pelvic pain, dysuria, fever, or systemic symptoms. Sexual function remained preserved and normal erectile function and orgasm were also maintained. He denied recent UTI, trauma, and STDs. Medical history was unremarkable except for BPH. He was not on anticoagulation or medications affecting ejaculation. Serum PSA was 1.2 ng/mL, age-appr

FAQs

What symptoms developed after TURP in this case?

Six months after TURP, the patient developed hemospermia and hypospermia with blood-tinged semen and reduced ejaculatory volume.

How was the ejaculatory duct cyst identified and confirmed?

Pelvic MRI showed a 12 mm cyst in the ejaculatory duct region above the verumontanum, and cystoscopy confirmed the finding.

Why was conservative surveillance selected instead of immediate intervention?

The cyst was small, ejaculation was partially preserved, the patient’s age was considered, and family planning was completed, supporting a conservative monitoring approach.

Sep 30, 2026

Uploaded by Rizky