The authors describe their experience with percutaneous transperineal puncture (PTP) of the seminal vesicles in andrologic pathologic conditions, using transrectal US guidance. Three cases are reported: 2 anomalies of the genital ducts and one prostatic-vesicular abscess. In the first two cases PTP allowed a diagnosis to be reached on the basis of the analysis of vesicular fluid. Moreover, the examination allowed the selection of the patients to be submitted to surgery for seminal duct anomaly (endoscopic resection of the colliculus seminalis). In cases 1 and 3 PTP allowed the aspiration of the fluid from a cyst in the left ejaculatory duct and from a prostatic-vesicular abscess, respectively. These procedures were facilitated using US guidance. The clinical possibilities and utility of PTP have not yet been completely defined. The authors suggest a diagnostic protocol to be used in the presence of azoocytospermia, where US must be performed only in patients with excretory infertility. The present paper must be considered a work in progress. Further study is required to identify the clinical indications of interventional US of the seminal vesicles in patients with andrologic pathologic conditions.