Retrovesical mass in men: Pitfalls of differential diagnosis

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 yea rs old (mean age 47.1) presented with symptoms or signs of a retrovesical m ass. Clinical features and diagnostic findings were reviewed, and related t o 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 cys t in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoi d liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obtu ratoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 p atients various symptoms were seen and in 4 the mass was incidentally detec ted. A mass was palpable on digital rectal examination in 16 cases and visi ble on sonography in 20. For a cystic mass medial location relative to the bladder neck was suggestive of prostatic abscess or utricle cyst, while lat eral location was suggestive of seminal vesicle cyst/hydrops or empyema, ec topic ureter or ureterocele. In 6 patients diagnosis was established only b y exploratory laparotomy and histopathological examination. Conclusions: Digital rectal examination and sonography reliably detect a re trovesical mass. Nevertheless, clinical signs and median or lateral locatio n 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 i n most cases to establish a histopathological diagnosis. Exploratory laparo tomy and histopathological examination are the procedures of choice when ot her findings are equivocal.