The feasibility and safety of applying all-seeing needle in transurethral seminal vesiculoscopy

Abstract

Objective To detect the feasibility and safety of applying all-seeing needle in transurethral seminal vesiculoscopy. Methods Retrospective analysis was made with clinical data of 32 patients of hemospermia treated with transurethral seminal vesiculoscopy using all-seeing needle from March 2016 to January 2018. The patients ' age was (38.8 ± 8.7) years (27-60 years) and the course of disease was (7.1±3.3) months (2-15 months). Ultrasound before operation showed heterogeneous echo, or expansion of the seminal vesicle. MRI showed hemorrhage of the seminal vesicle, or abnormal signal of the seminal vesicle. Patients had levofloxacin or mosisasin anti-infection therapy more than one month and remained uncovered. The operation was performed under subarachnoid anesthesia, and the patients took the lithotomy position. The F4.8 all-seeing needle entered the posterior urethra, the verumontanum was found, and the saline was slowly pushed with a syringe to maintain a clear view. Then, the ejaculatory duct opening was searched on both sides of the verumontanum. If the ejaculatory duct opening cannot be found in the normal position, we entered the needle into the prostatic utricle to find the possible ectopic opening. If the ejaculatory duct opening was still not found, at the 5 and 7 o'clock positions in the prostatic utricle, the needle was probed and punctured into the side wall of the ejaculatory duct. Visible puncture with all-seeing needle can effectively avoid penetrating blood vessels and reduce damage to tissues during puncture. In this study, the ejaculatory duct opening got accessed on the verumontanum in 14 cases, through ectopic openings within the prostatic utricle in 2 cases, and through artificial establishment in 5 and 7 o’clock positions within prostatic utricle in 16 cases. After entering the ejaculatory duct and seminal vesicle, we explored the cavities of the seminal vesicles. For stones or polyps, after replacing the outer sheath to F8, F1.9 stone retrieval basket was applied to remove stones or polyps, followed by rinsing the seminal vesicles with normal saline, 0.02% nitrofurazone, and then 160, 000 units of gentamicin into each seminal vesicle. For hemorrhage, after clearing up the blood, seminal vesicles were also washed with normal saline, nitrofurazone, and perfused with gentamicin. In the operation, prostatic utricle stone was found in 5 cases, and seminal vesicle stone was found in 7 cases. One case of seminal vesicle polyp was observed, and in 19 cases, seminal vesicle hemorrhage was seen. Results All the operations were accomplished successfully, the operation time was (55.0±11.3)min (35-82 min). There was no rectal injury or urethral injury during operation. The postoperative catheter was removed at 2 days postoperatively and the patients discharged on the 4th day after surgery. The length of hospital stay was (6.3±0.7) days (5-7 days). One patient had mild hematuria after removal of the urethral catheter and got improved spontaneously; one case developed epididymitis, which improved after anti-infective treatment. 6 cases made stone analysis, with 5 cases of magnesium ammonium phosphate hexahydrate, and 1 case of calcium oxalate dihydrate, calcium oxalate monohydrate and carbonate apatite mixed stones. One case of polyp was diagnosed by pathologists to be an inflammatory polyp. Follow-up was performed at 4, 6, 8, and 12 weeks after surgery. Hemospermia was cured in 24 cases, relieved in the other 8 cases at 8-week follow-up, who received oral antibiotic treatment afterwards. At the 12-week follow-up, the rest 6 cases in 8 got hemospermia recovered, with 2 cases still uncovered. Conclusions All-seeing needle is user-friendly and safe in transurethral seminal vesiculoscopy, with reliable short-term efficacy. Key words: Hemospermia; Seminal vesiculoscopy; All-seeing needle