Seminal vesicle cysts, seminal vesicle tumors, and complications following male sterilization (Chapter 11)
What is a seminal vesicle cyst?
Seminal vesicle cysts typically present with few clinical symptoms. However, as the cyst grows larger, lower abdominal or lumbar pain may occur. Other symptoms may include hematospermia (blood in semen) or bloody discharge from the urethra, and sometimes urinary obstruction. A cyst may be palpable on one side of the seminal vesicle during a digital rectal examination or bimanual abdominal examination. Ultrasound, CT, MRI, and seminal vesiculography can all determine the size and location of the cyst.
Treatment of seminal vesicle cysts
Treatment depends on the size and presentation of the cyst. Small cysts are treated conservatively, but close observation is required. Larger cysts can be removed through the lower abdomen or perineum, or a sac-like procedure can be performed through the bladder or suprapubic region to drain the cyst.
What is a seminal vesicle tumor?
Seminal vesicle tumors are classified into primary and secondary types. Primary tumors are mostly epithelial papillomas and seminal vesicle carcinomas, but stromal sarcomas are also possible. Secondary seminal vesicle tumors can originate directly from prostate cancer, rectal cancer, and bladder cancer, or they can be metastasized from tumors in other organs to the seminal vesicles.
The main clinical manifestation is hematospermia, along with urinary frequency, urgency, and hematuria. Urinary obstruction and difficulty urinating may also occur, causing pain in the lower abdomen, groin, or testicles. Late-stage symptoms include anemia, fatigue, and weight loss. If the tumor compresses the rectum, it can deform the stool, leading to difficulty in defecation.
Treatment of seminal vesicle tumors
If a seminal vesicle tumor is definitively diagnosed, a wide resection including the prostate and bladder should be performed as early as possible. If tumors are present in both the prostate and seminal vesicle, bilateral orchiectomy and estrogen therapy should be considered. The prognosis for seminal vesicle tumors is generally poor.
Chapter 11 Complications after Male Sterilization
Does vasectomy affect male sex hormones and sexual function?
Vasectomy is a procedure that achieves contraception by blocking the passage of sperm.
After tubal ligation, one can still maintain normal libido, ejaculate normally during sexual intercourse, experience the sensation of ejaculation, and have sexual pleasure, although the semen will not contain sperm.
Scientific research shows that although the vas deferens is ligated and sperm cannot be ejaculated, the spermatogenic function of the testicular seminiferous epithelium is unaffected. Sperm production continues, although all sperm are absorbed by the epididymis after production. Because the testes are not damaged and maintain normal secretory function, it does not affect male sexual function or male characteristics (such as voice, body hair, and Adam's apple). Therefore, vasectomy is a safe and reliable method of male sterilization.
Reproductive physiology and endocrine theory have now clarified that the testes have two main functions: producing sperm and secreting male hormones. The primary male hormone is testosterone, a steroid hormone produced by interstitial cells in the tissue surrounding the seminiferous tubules and entering the bloodstream directly (not through the vas deferens). This male hormone plays a crucial role in promoting the development of male accessory glands and male sexual characteristics, and maintaining sexual function. Vasectomy does not affect the secretion of male hormones, and therefore does not affect male sexual characteristics or sexual function.
Without vasectomy, sperm are produced by the seminiferous epithelium in the seminiferous tubules of the testes, mature in the epididymis, and then pass through a series of ductal systems including the vas deferens and ejaculatory ducts before being expelled through the urethra. During this process, secretions from accessory glands (prostate gland, seminal vesicles, bulbourethral glands, and paraurethral glands) are also added, contributing to the ejaculation of semen. After vasectomy, only the sperm ejaculation ducts are blocked, and the semen no longer contains sperm. However, it does not affect the formation and expulsion of secretions from the accessory glands that make up semen (which account for more than 90% of semen volume). Therefore, vasectomy does not affect the quality of sexual life.
Like all endocrine hormones in the human body, testosterone is secreted and metabolized directly from its secretory organs into the bloodstream. After being produced by the interstitial cells of the testes, testosterone enters the bloodstream directly from the testes and is distributed throughout the body via blood circulation to exert its physiological effects. Its secretion and transport pathway is unrelated to sperm transport. According to a study conducted by seven scholars between 1975 and 1978 on 761 cases of vasectomy, the blood testosterone concentration before and after the procedure showed no significant change. Therefore, vasectomy does not affect the secretion and release of testosterone. Its concentration in the blood and its physiological effects remain unchanged before and after the procedure.
Of course, the secretion and release of male hormones in the human body are not constant; they are controlled by gonadotropins secreted by the pituitary gland, an endocrine organ located in the lower part of the brain. Scientific research has discovered a hypothalamic-pituitary-testicular axis in the male body. This regulatory system is controlled by the cerebral cortex. In other words, the secretion and release of male sex hormones and sexual function are closely related to the activity of the cerebral cortex. Therefore, when studying infertility, the influence of mental and psychological factors should be considered.