Etiology of 305 cases of refractory hematospermia and therapeutic options by emerging endoscopic technology

Liang-Gong Liao,Yong Zhang,Qi Wang,Tong Zhu,Ke Li,Yan-Feng Li,Bo-Jun Li,Bo Zhou,Jun Jiang,Xu-Dong Liu,Yong Luo

doi:10.1038/s41598-019-41123-2

Abstract

To investigate the surgical outcomes of vesiculoscopy on refractory hematospermia and ejaculatory duct obstruction (EDO), the clinical data (including pelvic magnetic resonance imaging (MRI) examinations and the long-term effects of endoscopic treatment) from 305 patients were analyzed. Four main etiologic groups were found on MRI. We found that 62.0% (189/305) of patients showed abnormal signal intensity in MRI investigations in the seminal vesicle (SV) area. Cystic lesions were observed in 36.7% (112/305) of the patients. The third sign was dilatation or enlargement of unilateral or bilateral SV, which were observed in 32.1% (98/305) of the patients. The fourth sign was stone formation in SV or in an adjacent cyst, which was present in 8.5% (26/305) of the patients. The transurethral endoscopy or seminal vesiculoscopy and the related procedures, including fenestration in prostatic utricle (PU), irrigation, lithotripsy, stone removal, biopsy, electroexcision, fulguration, or transurethral resection/incision of the ejaculatory duct (TURED/TUIED), chosen according to the different situations of individual patients were successfully performed in 296 patients. Fenestrations in PU+ seminal vesiculoscopy were performed in 66.6% (197/296) of cases. Seminal vesiculoscopy via the pathological opening in PU was performed in 10.8% (32/296) of cases. TURED/TUIED + seminal vesiculoscopy was performed in 12.8% (38/296) of cases, and seminal vesiculoscopy by the natural orifices of the ejaculatory duct (ED) was performed in 2.4% (7/296) of cases. Electroexcision and fulguration to the abnormal blood vessels or cavernous hemangioma at posterior urethra were performed in 7.4% (22/296) of cases. Two hundred and seventy-one patients were followed up for 6–72 months. The hematospermia of all the patients disappeared within 2–6 weeks, and 93.0% of the patients showed no further hematospermia during follow-up. No obvious postoperative complications were observed. The transurethral seminal vesiculoscopy technique and related procedures are safe and effective approaches for refractory hematospermia and EDO.

Highlights

Hematospermia, which is traditionally defined as the appearance of blood in the seminal fluid, has been recognized for centuries[1]
These changes can be divided into the following four groups: (1) The most common sign viewed by magnetic resonance imaging (MRI) was abnormal signal intensity in the seminal vesicle (SV) area, and it was observed in 62.0% (189/305) of patients, in which 26.2% (80/305) of the patients presented medium to high signal intensity on T1-weighted images and low signal intensity on T2-weighted images in unilateral or bilateral SV
The other 35.7% (109/305) of the patients had middle to high signal intensity on both T1-weighted and T2-weighted images, and those were confirmed to have old hemorrhages in the SV by seminal vesiculoscopy (Fig. 2). (2) The second most common change was cystic www.nature.com/scientificreports lesions in the ejaculatory duct (ED) area, which were present in 36.7% (112/305) patients, with or without differences in internal signal intensity or dilatation of the SV

Summary

Introduction

Hematospermia, which is traditionally defined as the appearance of blood in the seminal fluid, has been recognized for centuries[1]. There are still many controversial questions or focused problems to be discussed, such as the method for identifying the opening of the ejaculatory duct (ED), the insertion approach for the seminal vesiculoscope, the characteristic magnetic resonance imaging (MRI) changes of refractory hematospermia and their management strategy, and the prevention of postoperative complications. With respect to these questions, the present study retrospectively summarized the clinical data of 305 patients with persistent or recurrent hematospermia or ejaculatory duct obstruction (EDO), their management techniques, and strategies with the emerging transurethral endoscopy.

Methods

Results

Conclusion