A 25-year-old male presented with bilateral scrotal pain for 8 months. The pain was constant, dull aching, aggravated by sexual intercourse and affecting quality of life. He also had lower urinary tract symptoms like frequency, urgency and incomplete evacuation which were not bothersome. He is married with 2 children. He denies history of urethritis or other sexually transmitted diseases in the past. He was treated in different places as urinary tract infection, epididymitis and has taken multiple courses of antibiotics. He did not have any relief of symptoms. He later underwent left inguinal hernioplasty 6 months back in another hospital. There is no available record of the surgery. But his symptoms persisted. He then presented to our clinic. He had no medical comorbidities. Clinical examination revealed bilateral grossly enlarged, thickened and tender vasa, which were cord like, up to external ring. Both testes and epididymis were, however, normal. Rectal examination was unremarkable. Complete hemogram and renal parameters were normal. Urine culture was sterile. Uroflowmetry showed intermittent flow pattern. Peak flow rate was 10.5 ml/s with residual urine of 55 ml. Suspecting a diagnosis of stricture and to rule out reflux vasitis, retrograde urethrogram and micturition cystourethrogram (RGU and MCU) were done (Fig. 1).
RGU showed normal urethra without any reflux into prostatic ducts or seminal vesicles. Surprisingly, cystogram showed a “pear shaped bladder” suggestive of pelvic lipomatosis. Magnetic resonance imaging (MRI) confirmed “Pelvic lipomatosis with bilateral thickened and edematous vasa (Vasitis).” The dilated vas was prominently seen in the pelvis with hour glass compression of bladder and surrounding pelvic lipomatosis giving a “Donald Duck” appearance (Fig. 2). Since he had already taken different antibiotic courses in the past, he was not given any further antibiotics. Patient was treated with anti-inflammatory medication (Celecoxib) for 4 weeks. He is on regular follow-up for the last few months and is symptomatically better. Clinical examination revealed persistent dilated vas, but the tenderness was no longer present even after completion of anti-inflammatory medication. Follow-up ultrasound abdomen and scrotum did not show any new compressive conditions. He has been advised to come for regular review.