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discussed in detail in previous reports.3,4 With regard to using this technique for diagnosing seminal vesicle tumors, several technical skills are worth noting. Firstly, the orifice to the verumontanum or seminal vesicle could occasionally not be found. As illustrated in Figure 1a, it was not possible to locate the orifice of the verumontanum when the seminal vesicle tumor had invaded the urethra, but it was easy to obtain tumor tissue in such a situation. Secondly, once the ureteroscope was inserted into the lumen of the verumontanum, it was usually occupied with neoplasms that had migrated to the lumen from the unilateral seminal vesicle (Figure 1b). Therefore, it was extremely difficult to puncture the seminal vesicle with the head of Zebra guidewire because the normal anatomic structure had changed considerably, and space for maneuvering was extremely limited. In fact, it was not necessary to try to puncture the seminal vesicle when sufficient tumor tissue could be obtained for pathological evaluation (Figure 1c). The duration of operations involving seminal vesiculoscopy was between 15 and 25 min, and in all patients sufficient tumor tissue was obtained for pathologic evaluation (Table 1). There were no intraoperative or postoperative complications. After pathological confirmation of a malignant seminal vesicle tumor, all of the patients underwent open cystoprostatico-vesiculectomy with pelvic lymph node dissection and urinary diversion. The four patients in our study did not receive chemotherapy, radiotherapy or anti-androgenic therapy after surgery. The pathological results of the seminal vesiculoscopy biopsy were confirmed by the gross pathology. The advent of advanced imaging technology, for example TURS, MRI and computed tomography (CT), has improved sensitivity regarding the detection of abnormalities of the seminal vesicles; however, these imaging modalities have limited specificity concerning the differentiation of prostate cancer and primary tumors of the seminal vesicle.6 In the present study, using all of the various examination techniques such as TRUS, CT and MRI the seminal vesicle masses were suspected as originating from prostate cancer; this was because prostate cancer is a common malignant disease in elderly patients and the imaging characteristics are difficult for radiologists to differentiate. Transrectal needle biopsy with TRUS guidance is an important approach in the differentiation of such unknown seminal vesicle masses. However, false negative results from transrectal needle biopsies are a serious concern. It should be noted that nearly 45% of patients have been reported to require exploration of the small pelvis Dear Editor, Primary tumors of the seminal vesicle are extremely rare in the genitourinary system. There have only been about 70 cases reported in the literature since the first case of primary seminal vesicle carcinoma was reported in 1925 by Lyons.1 Seminal vesicle tumors are often difficult to diagnose at an early stage because of a lack of typical symptoms. Moreover, differentiation of the seminal vesicle mass from secondary tumor invasion into adjacent organs has also been a difficult problem for urologists.1 Nevertheless, accurate and prompt diagnosis of this tumor is important, since timely treatment is associated with improved long-term survival.2 With the development of seminal vesiculoscopy, numerous seminal vesicle diseases can now be diagnosed and treated using this technique; however, there has been no previous study involving the use of seminal vesiculoscopy in the diagnosis of primary seminal vesicle tumors.3–5 Seminal vesiculoscopy has been performed for the diagnosis and treatment of seminal vesicle diseases in our center since February 2006, and to date >1000 patients have undergone examination using this modality.3 In the present study, seminal vesiculoscopy was innovatively used for the diagnosis of seminal vesicle tumors. The ejaculatory duct and seminal vesicle could be observed, and sufficient tumor samples could be obtained for pathological examination. From December 2006 to March 2014, four patients with seminal vesicle masses were diagnosed as having primary tumor of the seminal vesicle using seminal vesiculoscopy in our center. Serum analysis and special examinations such as those involving prostate specific antigen, carcinoembryonic antigen, cancer antigen 125, transrectal ultrasonography (TURS) and magnetic resonance imaging (MRI) failed to differentiate these seminal vesicle masses from prostate cancer with seminal vesicle invasion. Transrectal biopsy revealed that two of three patients were suspected of having a primary seminal vesicle tumor while the third had benign prostate hyperplasia (Table 1). All patients underwent seminal vesiculoscopy; the protocol and skills required for performing seminal vesiculoscopy in our department have been The feasibility and experience of using seminal vesiculoscopy in the diagnosis of primary seminal vesicle tumors