Abstract Introduction Epidermoid cysts of the seminal vesicle are uncommon, benign lesions and usually asymptomatic and are therefore most often detected incidentally on imaging. Diagnosis can be confirmed using transrectal ultrasound, computed tomography (CT), with MRI frequently regarded as the gold standard for delineating lesion characteristics. Management strategies depend on symptomatology: asymptomatic cysts may be managed conservatively with observation, whereas those presenting with complications such as pain, hemorrhage, or infection may require aspiration, transurethral resection, or definitive excision by minimally invasive procedures such as laparoscopy or robotic-assisted surgery. Objective To elucidate the relationship between lesion anatomy and clinical presentation, define diagnostic standards, review treatment indications, and establish follow-up strategies for seminal vesicle epidermoid cysts. Methods We describe the clinical course of a 39-year-old male with a history of recurrent epididymitis requiring hospitalization, who presented with persistent hematospermia and persistent genital discomfort. MRI detected a cystic mass arising from the right seminal vesicle, and further uro-CT imaging was performed to rule out congenital causes. An attempt to access the cyst through retrograde endoscopic catheterization via the prostatic urethra was unsuccessful. Due to refractory symptoms and his clinical background, the patient underwent a right-sided seminal vesiculectomy using a laparoscopic approach assisted by the da Vinci X robotic platform. Histopathology confirmed the diagnosis of a seminal vesicle epidermoid cyst. Results The patient underwent a successful right-sided laparoscopic seminal vesiculectomy with robotic assistance using the da Vinci X system. The surgery proceeded without intraoperative complications, and the patient tolerated the procedure well. Surgical Technique: Access to the seminal vesicle was achieved through a peritoneal incision located 2 cm anterior to the pouch of Douglas. Dissection proceeded through an avascular plane, identifying the seminal vesicle and vas deferens. The cyst was carefully dissected away from the prostate, with separation of the vas deferens. A reference suture was placed at the distal end before transecting the cyst. The specimen was retrieved using an endoscopic bag. Postoperative cystography confirmed absence of urinary leakage, and MRI at three-month follow-up demonstrated complete lesion excision. Conclusions In summary, the management of seminal vesicle epidermoid cysts is fundamentally symtom-driven. Surgical intervention for seminal vesicle epidermoid cysts is indicated solely for symptomatic patients. The current optimal technique is minimally invasive vesiculectomy (laparoscopic or robotic), which provides excellent outcomes through enhanced visualization and faster recovery. n summary, the management of seminal vesicle epidermoid cysts is fundamentally symptom-driven. Surgical intervention. n summary, the management of seminal vesicle epidermoid cysts is fundamentally symptom-driven. Disclosure No
Rodríguez-Gomez et al. (Mon,) studied this question.