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Retained Seminal Vesicles After Radical Prostatectomy: Frequency, MRI Characteristics, and Clinical Relevance

Tamar Sella1,2, Lawrence H. Schwartz1 and Hedvig Hricak1

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Room C-278, New York, NY 10021.
2 Department of Radiology, Hadassah University Hospital, Jerusalem, Israel.


Figure 1
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  		Fig. 1A —60-year-old man 12 years after radical prostatectomy for prostate adenocarcinoma. B = bladder, R = rectum. T2-weighted axial endorectal-coil MR image shows multiple surgical clips with susceptibility artifact in region of seminal vesicles (arrows). This artifact makes it difficult to assess images for retained seminal vesicle remnants.

 

Figure 2
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  		Fig. 1B —60-year-old man 12 years after radical prostatectomy for prostate adenocarcinoma. B = bladder, R = rectum. Axial CT scan, acquired 1 month earlier, confirms metallic nature of these clips.

 

Figure 3
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  		Fig. 2A —61-year-old man with Gleason grade 8 prostate cancer 6 months after radical retropubic prostatectomy. R = rectum, B = bladder. T2-weighted axial (A), coronal (B), and sagittal (C) endorectal-coil MR images show bilaterally complete, intact, retained seminal vesicles (arrows). Remnants show convoluted structure characteristic of normal seminal vesicles. Tubules show high signal intensity on T2-weighted images, indicating their fluid content. Ductus deferens (asterisks, A and B) are also noted.

 

Figure 4
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  		Fig. 2B —61-year-old man with Gleason grade 8 prostate cancer 6 months after radical retropubic prostatectomy. R = rectum, B = bladder. T2-weighted axial (A), coronal (B), and sagittal (C) endorectal-coil MR images show bilaterally complete, intact, retained seminal vesicles (arrows). Remnants show convoluted structure characteristic of normal seminal vesicles. Tubules show high signal intensity on T2-weighted images, indicating their fluid content. Ductus deferens (asterisks, A and B) are also noted.

 

Figure 5
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  		Fig. 2C —61-year-old man with Gleason grade 8 prostate cancer 6 months after radical retropubic prostatectomy. R = rectum, B = bladder. T2-weighted axial (A), coronal (B), and sagittal (C) endorectal-coil MR images show bilaterally complete, intact, retained seminal vesicles (arrows). Remnants show convoluted structure characteristic of normal seminal vesicles. Tubules show high signal intensity on T2-weighted images, indicating their fluid content. Ductus deferens (asterisks, A and B) are also noted.

 

Figure 6
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  		Fig. 3 —46-year-old man with Gleason grade 8 prostate cancer 10 months after retropubic radical prostatectomy. T2-weighted axial endorectal-coil MR image shows retained low-signal-intensity lateral portion of seminal vesicle on left (arrows). Medial to seminal vesicle remnant, adjacent to rectum, is soft-tissue mass of intermediate signal intensity (asterisk), suggestive of local recurrence. Transrectal sonography-guided biopsy of mass showed prostatic adenocarcinoma. Configuration and signal intensity differ between presumably fibrotic seminal vesicle remnant and local recurrence. Seminal vesicle remnant is of lower signal intensity (similar to adjacent pelvic muscles) and has irregular, convoluted shape. B = bladder, R = rectum, M = muscles.

 

Figure 7
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  		Fig. 4A —64-year-old man with Gleason grade 6 prostate cancer 60 months after retropubic radical prostatectomy. R = rectum, B = bladder. T2-weighted axial (A) and coronal (B) endorectal-coil MR images show unilaterally retained right seminal vesicle tip (solid arrow). Seminal vesicle remnant is fluid-filled and intact. Left ductus deferens stump (open arrow, A) is also visualized.

 

Figure 8
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  		Fig. 4B —64-year-old man with Gleason grade 6 prostate cancer 60 months after retropubic radical prostatectomy. R = rectum, B = bladder. T2-weighted axial (A) and coronal (B) endorectal-coil MR images show unilaterally retained right seminal vesicle tip (solid arrow). Seminal vesicle remnant is fluid-filled and intact. Left ductus deferens stump (open arrow, A) is also visualized.

 

Figure 9
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  		Fig. 4C —64-year-old man with Gleason grade 6 prostate cancer 60 months after retropubic radical prostatectomy. R = rectum, B = bladder. Axial CT image shows soft-tissue mass (arrow) on right, between bladder and rectum, correlating with retained seminal vesicle.

 

Figure 10
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  		Fig. 5A —56-year-old man with Gleason grade 7 prostate cancer 86 months after retropubic radical prostatectomy. B = bladder, R = rectum, M = muscles. T2-weighted axial (A) and coronal (B) endorectal-coil MR images show bilaterally symmetric low-signal-intensity masses situated where tips of seminal vesicles were presurgically. These masses are suggestive of retained tips of seminal vesicles (arrows) and show low signal intensity similar to that of adjacent pelvic muscles, suggestive of fibrosis. As seminal vesicles undergo fibrosis, they tend to pull down along lateral rectal wall. Low signal intensity, bilaterality, and symmetry of these remnants distinguish them from local recurrence of prostate cancer.

 

Figure 11
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  		Fig. 5B —56-year-old man with Gleason grade 7 prostate cancer 86 months after retropubic radical prostatectomy. B = bladder, R = rectum, M = muscles. T2-weighted axial (A) and coronal (B) endorectal-coil MR images show bilaterally symmetric low-signal-intensity masses situated where tips of seminal vesicles were presurgically. These masses are suggestive of retained tips of seminal vesicles (arrows) and show low signal intensity similar to that of adjacent pelvic muscles, suggestive of fibrosis. As seminal vesicles undergo fibrosis, they tend to pull down along lateral rectal wall. Low signal intensity, bilaterality, and symmetry of these remnants distinguish them from local recurrence of prostate cancer.

 

Figure 12
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  		Fig. 6A —50-year-old man with Gleason grade 8 prostate cancer. B = bladder, R = rectum. T2-weighted axial endorectal-coil MR images before (A) and 15 months after (B) retropubic radical prostatectomy. Normal seminal vesicles are noted before surgery (black arrows, A). Bilateral low-signal-intensity seminal vesicle remnants are noted (white arrows, B) in similar position in pelvis after surgery.

 

Figure 13
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  		Fig. 6B —50-year-old man with Gleason grade 8 prostate cancer. B = bladder, R = rectum. T2-weighted axial endorectal-coil MR images before (A) and 15 months after (B) retropubic radical prostatectomy. Normal seminal vesicles are noted before surgery (black arrows, A). Bilateral low-signal-intensity seminal vesicle remnants are noted (white arrows, B) in similar position in pelvis after surgery.

 

Figure 14
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  		Fig. 7A —65-year-old man with Gleason grade 7 prostate cancer. B = bladder, R = rectum. T2-weighted sagittal endorectal-coil MR image obtained 20 months after retropubic radical prostatectomy shows complete, intact, retained seminal vesicle (arrow).

 

Figure 15
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  		Fig. 7B —65-year-old man with Gleason grade 7 prostate cancer. B = bladder, R = rectum. Image of same site 16 months later shows smaller seminal vesicle of lower signal intensity (arrow), suggestive of fibrosis. In interval, patient received hormonal therapy for rising level of prostate-specific antigen.

 

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