MALE INFERTILITY DUE TO A BENIGN PROSTATIC POLYP

Abstract

Prostatic polyps are rare benign lesions. They are derived from hyperplastic prostate tissue and usually appear as exophytic growths in the posterior urethra. We report on a patient with a prostatic urethral polyp found incidentally during evaluation for male factor infertility. The polyp caused partial ejaculatory duct obstruction, which was corrected following surgical resection. CASE REPORT A 36-year-old man presented for evaluation of male infertility. He and his partner had undergone 2 failed attempts at in vitro fertilization. Following these cycles, a full-term pregnancy was naturally achieved. However, the newborn died at age 4 days due to spinal muscular atrophy. History was significant for left varicocelectomy and a recent episode of gross painless hematuria. Physical examination was remarkable for left testicular atrophy. Laboratory studies revealed microscopic hematuria. Hormonal profile was normal. Multiple semen analyses revealed an average value of 0.9 ml., 10.8 million total sperm count and 29% motility. Hematuria evaluation included urinalysis and culture, urine cytology and magnetic resonance imaging (MRI) of the abdomen and pelvis. MRI identified a 1 cm. cystic mass in the prostatic urethra associated with prominent seminal vesicles (fig. 1). Cystoscopy demonstrated a normal bladder and trigone, and confirmed a 2 cm. grayish papillary mass arising from the verumontanum in the prostatic urethra. Transurethral resection was performed and efflux of milky, viscous fluid was demonstrated at the base of the resection. Efflux of additional fluid was observed at this location during intraoperative massage of the seminal vesicles. Pathological examination revealed a benign prostatic polyp (fig. 2). Several semen analyses 1 month postoperatively were improved with a mean ejaculatory volume of 5.2 ml., total count of 36 million and motility of 57%. The couple conceived naturally 2 months postoperatively, and a healthy male neonate was delivered at term without any congenital abnormalities.