RETROVESICAL MASS IN MEN

PITFALLS OF DIFFERENTIAL DIAGNOSIS

DAHMS, STEFAN E.
HOHENFELLNER, MARKUS
LINN, JURGEN F.
EGGERSMANN, CHRISTIAN
HAUPT, GERALD
THUROFF, JOACHIM W.

From the Department of Urology, Johannes Gutenberg University, School of Medicine, Mainz, Department of Urology and Pediatric Urology, University of Witten/Herdecke, School of Medicine, Klinikum Barmen, Wuppertal and Department of Urology, Ruhr University, School of Medicine, Herne, Germany
Accepted for publication November 20, 1998.

Journal of Urology 161(4):p 1244-1248, April 1999.

Purpose

We review the differential diagnosis and treatment of retrovesical masses in men.

Materials and Methods

During the last 8 years 21 male patients 3 to 79 years old (mean age 47.1) presented with symptoms or signs of a retrovesical mass. Clinical features and diagnostic findings were reviewed, and related to surgical and histopathological findings.

Results

The retrovesical masses included prostatic utricle cyst in 3 cases, prostatic abscess in 1, seminal vesicle hydrops in 6, seminal vesicle cyst in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoid liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obturatoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 patients various symptoms were seen and in 4 the mass was incidentally detected. A mass was palpable on digital rectal examination in 16 cases and visible on sonography in 20. For a cystic mass medial location relative to the bladder neck was suggestive of prostatic abscess or utricle cyst, while lateral location was suggestive of seminal vesicle cyst/hydrops or empyema, ectopic ureter or ureterocele. In 6 patients diagnosis was established only by exploratory laparotomy and histopathological examination.

Conclusions

Digital rectal examination and sonography reliably detect a retrovesical mass. Nevertheless, clinical signs and median or lateral location relative to the bladder neck on ultrasound are diagnostic only for cystic lesions. Computerized tomography and magnetic resonance imaging are useful for staging malignant tumors. However, needle or open biopsy is required in most cases to establish a histopathological diagnosis. Exploratory laparotomy and histopathological examination are the procedures of choice when other findings are equivocal.