X-ray (vesiculography) of seminal vesicles

The issue of diagnosing male reproductive health is relevant for men of almost all age groups. Violations and pathologies in this area not only worsen the general well-being and health of a man, but also his morale, self-confidence, and satisfaction with life.

Modern urology offers various methods for examining and detecting diseases of the genitourinary system in men. Among them is vesiculography, or x-ray of the seminal vesicles. This type of diagnosis is a study of the condition of the seminal vesicles using x-rays. The procedure is performed with the use of a contrast agent.

The structure of the seminal vesicles, their location and functional features

The seminal vesicles are a paired organ in the male body. They are two hollow, bag-shaped formations located above the prostate gland. The normal size of the bubble is 6-8 centimeters in length, 1,5-2 centimeters in width, their thickness is from 0,5 to 1 centimeter. Anatomically, they distinguish between the anterior and posterior surfaces. Their front part is adjacent to the bladder, behind them is the anterior wall of the ampullar part of the rectum. In this place between the organs there is a vesico-rectal septum.

Each vesicle consists of a body and a neck. The upper part of these organs is covered by the peritoneum, the rest is outside the peritoneal space. The continuation of the neck of the vesicles are the excretory ducts, which then open into the side wall of the ampulla of the vas deferens. Above the body of the seminal vesicles are the ureters. From top to bottom, the bubbles seem to converge together.

These small “bags” in a man’s body perform several important functions that affect the quality of sperm and the ability to conceive a child. Up to 75% of the total volume of seminal fluid is produced by seminal vesicles. They accumulate and store components of the seminal fluid, except for spermatozoa, until the moment of ejaculation. In turn, spermatozoa “live” in the ampullae of the vas deferens.

Bubbles take part in the very mechanism of ejaculation. At the moment when ejaculation occurs, the contents of the vesicles, together with the components stored in the vas deferens, enter the urethra, where it mixes with the secretion of the prostate, and then goes out.

Pathological changes in the seminal vesicles are a common cause of male infertility.

What does vesiculography of seminal vesicles show, why is it prescribed

Due to the peculiarities of the structure and location of these organs, as well as the absence of specific signs of their pathological disorders, diseases of the seminal vesicles are difficult to diagnose. There are methods for examining organs that are not associated with X-ray exposure, such as taking their contents for analysis, or finger palpation through the rectum, but in practice they show themselves to be ineffective.

Vesiculography, or X-ray of the seminal vesicles, allows, through the use of the properties of X-rays and a contrast agent, to detect:

• violations of the anatomical structure and location of organs;
• tumors, including malignant neoplasms;
• inflammatory and purulent processes;
• inflammation of the epididymis;
• tuberculous prostatitis and tuberculosis of the seminal vesicles.

The attending physician may prescribe a procedure for the purpose of:

• obtaining information about the structure, size, shape and location of the seminal vesicles in order to establish their compliance with the norm;
• identification of developing degenerative processes in organs;
• establishment of a primary or verification of a previously suspected diagnosis;
• determining the need for surgical intervention;
• monitoring the effectiveness of the prescribed treatment.

Types of vesiculography used in medicine

Depending on which diagnostic technique is chosen, vesiculography is distinguished:

• ascending;
• descending.

The differences lie in the method of introducing a contrast agent into the vas deferens: in the first case, the doctor uses an operating ureteroscope for catheterization, with the help of which the contrast agent is injected, in the second case, the injection is carried out by puncture.

Indications and contraindications for the appointment of the procedure

The most common reason why doctors prescribe vesiculography is the suspicion of oncological diseases, as well as tumors of any etiology.

In addition, indications for examination are:

• vesiculitis;
• infertility of unknown nature;
• epididymitis;
• suspicion of tuberculous prostatitis or tuberculosis of the seminal vesicles.

The diagnostic procedure is prohibited:

• in the presence of acute inflammatory processes in the prostate area;
• with inflammation of the seminal vesicles and urethra;
• if you have an allergy or intolerance to the contrast agent.

How is the preparation for the study carried out

The peculiarity of the preparation process is the presence of certain nutritional requirements. All foods containing a large amount of coarse fiber and causing increased gas formation are excluded 2-3 days before the scheduled date of diagnosis. In particular, the following are prohibited:

• beans;
• dairy and dairy products;
• black bread, pastry;
• alcohol, carbonated drinks.

2 hours after each meal, you should consume activated charcoal, 3-4 times a day.

On the day before the procedure, in the evening it is necessary to cleanse the intestines – a medical or mechanical method (enema) is suitable for this. Immediately before the procedure, you need to empty your bladder.

Method of vesiculography

The first such study of the human body was carried out in 1911. For these purposes, the bodies of deceased patients were used. In 1912, ascending vesiculography was done on a living patient for the first time. Later, in 1928, German doctors designed a special irrigation ureteroscope that could be used in the process of diagnosing seminal vesicles. Attempts to carry out the procedure according to the ascending type continued further, however, their effectiveness was rather low: in cases where the ejaculatory ducts open on the posterior slope of the seminal tubercle, it is almost impossible to catheterize them. For this reason, this technique is practically not used, in contrast to descending vesiculography.

You can carry out the procedure in any medical institution where there is an X-ray machine and a doctor of the appropriate qualification.

The descending type of vesiculography is used to diagnose diseases not only of the seminal vesicles, but also of the bladder, as well as the prostate gland, which are located close to the vesicles.

Doctors use iodine-based oily contrast agents in the process – iodipine, yodolipol at a concentration of 20 and 30%, respectively, as well as aqueous contrast solutions (50% sergosin solution or 70% triiotrasta). At the same time, aqueous contrast agents are used somewhat less frequently, since they are quickly removed from the cavity of the bubbles, which means that radiography should be carried out immediately after the contrast enters the body. Considering that the procedure has the character of a surgical intervention and is carried out in an operating room, it is extremely difficult to ensure instant fixation of x-rays immediately after the introduction of a coloring substance.

Oily preparations for x-ray contrast linger in the seminal vesicles for several days, give clearer and more informative vesiculograms.

The procedure begins with an injection of an anesthetic. To do this, the doctor first feels with his fingers the vas deferens on the back surface of the spermatic cord, and brings it closer to the scrotum. The doctor holds the duct with his fingers, and at the same time injects novocaine anesthesia to a depth of 2-3 centimeters. Further, a cap is applied to the skin of the scrotum, which covers the duct, so that the duct is surrounded on all sides by the skin of the scrotum, while remaining isolated from the spermatic cord.

After that, the doctor makes a longitudinal skin incision over the duct, no more than 2 centimeters long. In the dissection, a whitish-blue vas deferens will be visible, which must be freed from the membranes and taken on a provisional ligature. First, a thin needle is inserted into the lumen, after which it is removed, and another needle is inserted into the injection site – with a blunt end. It must be advanced 2-3 centimeters deep in the direction of the seminal vesicle. 2-3 milliliters of a contrast agent is injected through the needle into the duct, after which the needle is removed, the duct is released from the ligature and lowered into the scrotum. The skin incision is closed with 1-2 sutures. This method is called contrast vasopuncture.

Depending on whether an oil or aqueous solution of the drug was introduced, an x-ray image can be taken after an hour or two, or immediately after the suture.

The results of the survey

Normally, a vesiculogram shows a loop-shaped vas deferens that ascends through the inguinal canal and exits into the pelvic area. Near the posterior wall of the bladder, the duct joins the ampulla of the seminal vesicle. To assess the objective state of the seminal vesicles, bilateral vesiculography is recommended: for this, a bilateral puncture of the vas deferens is performed simultaneously or alternately.

Interpreting the diagnostic indications, the doctor studies the structure of the seminal vesicles, the height of their location, the angle between them, which is normally 90-95 degrees.

Chronic inflammation in the prostate and seminal vesicles in the picture can be recognized by the expansion of the vesicles themselves, and their displacement to the lateral side.

Tuberculous lesions are displayed as destructive changes in the body and the bottom of the vesicles – on the pictures they show additional cavities with an uneven contour.

Significant deformation, asymmetric location, filling defects and separate enlarged cavities indicate the likely presence of oncological diseases of the seminal vesicles.

With prostate adenoma, the pictures capture an abnormally high position of the bubbles, and an increase in the angle between them, up to 180 degrees.

If the patient has an obstruction of the seminal duct, some of the contrast agent will be detected in the bladder.

The results of vesiculography – pictures – are examined by a radiologist. He studies the general picture of the structure of the bubbles, their relationship to each other, size, shape, and prevalence of the contrast agent. Based on the pictures, the radiologist makes a conclusion. All these documents are handed over to the patient, and he gives them to his doctor, who sent him for examination.

Seminal vesicles can be affected by a variety of diseases – inflammatory processes, tumors, duct obstruction, and even tuberculosis. All these pathologies lead to a deterioration in well-being and the appearance of infertility. Vesiculography of the seminal vesicles is a minimally invasive way to study the male reproductive organs responsible for the production and preservation of sperm. Due to the filling of the cavities with a contrast agent, almost any changes and violations can be detected on the X-ray images, to study the size and location of the seminal vesicles, their relationship to each other and other organs. All these data play an important role for correct diagnosis and selection of treatment tactics.