How are seminal vesicle abnormalities diagnosed and treated?

Doctors diagnose seminal vesicle problems using history, semen analysis, lab tests, ultrasound or MRI, and sometimes endoscopy; treatment depends on cause and can include antibiotics, anti-inflammatories, procedures to clear blockages, surgery for cysts, and fertility support like IUI or IVF.

Diagnosis: step-by-step

1. Clinical history and exam: Ask about pain, blood in semen, low volume, infections, and fertility time-frame. A focused urogenital exam checks tenderness and prostate status.
2. Semen analysis: Measures volume, pH, fructose, viscosity, liquefaction time, sperm count, motility, and morphology. Low volume with low fructose and acidic pH can suggest ejaculatory duct issues or seminal vesicle dysfunction.
3. Laboratory tests: Urinalysis, semen culture, and inflammatory markers help identify infection or inflammation.
4. Imaging:
   • Transrectal ultrasound (TRUS): First-line for viewing seminal vesicles, ejaculatory ducts, cysts, and stones.
   • MRI pelvis: Detailed mapping when ultrasound is unclear or when congenital anomalies are suspected.
   • CT scan: Used selectively for complex cases.
5. Endoscopic evaluation: Cystoscopy or seminal vesiculoscopy may be used to see and treat intraductal problems.

Treatment options

• Infection/inflammation: Targeted antibiotics based on culture, anti-inflammatory medicines, hydration, and symptom control.
• Obstruction (EDO): Transurethral resection of the ejaculatory ducts (TURED) or endoscopic dilation to restore flow and increase semen volume.
• Cysts or stones: Drainage or removal through minimally invasive endoscopic or laparoscopic methods depending on size and symptoms.
• Congenital anomalies: Surgical correction is limited; fertility treatments such as sperm retrieval with IVF/ICSI are often considered.
• Supportive care: Lifestyle steps like hydration, balanced diet, reducing heat exposure, and managing chronic conditions (e.g., diabetes) can improve secretion quality.
• Fertility pathways: If semen parameters remain poor after treatment, assisted reproduction (IUI, IVF, or ICSI) can help achieve pregnancy.