Ejaculatory duct cyst mimicking post-TURP ejaculatory dysfunction: A diagnostic challenge in a patient with hemospermia and hypospermia.

Ejaculatory duct cysts are uncommon urological entities that can be difficult to diagnose after prostate surgery. We report a 60-year-old man who underwent TURP for a 65 g prostate and developed hemospermia and hypospermia six months later. Pelvic MRI identified a 12 mm cyst in the ejaculatory duct region above the verumontanum, confirmed cystoscopically. Post-ejaculatory urine contained no spermatozoa, while semen analysis showed oligoasthenospermia (8 million/mL, 15 % progressive motility, volume 0.8 mL). In view of the small cyst, partial preservation of ejaculation, patient age, and completed family planning, conservative surveillance was chosen. At six months, hemospermia regressed but hypospermia persisted.