Use of Mini Percutaneous Nephrolithotomy Nephroscope in Treating Ejaculatory Duct Stones

Abstract

Introduction and Objectives: Hematospermia is a common condition that can invoke a lot of anxiety in patients. Calculus obstruction of the ejaculatory duct is an unusual cause of hematospermia. We report a case of hematospermia caused by ejaculatory duct stones (EDS) diagnosed on imaging, and a subsequent successful and novel endoscopic approach to managing it. Methods: A 43-year-old man presented with intermittent hematospermia over 3 years. Initial investigations, including a serum prostate-specific antigen, urine and semen culture, and prostate ultrasonography, were normal. An MRI prostate, however, reported calcifications within the ejaculatory duct. The patient was counseled and planned for an endoscopic removal of the suspected EDS. Results: Using a 7.5F Ultra-Mini Nephroscope, the ejaculatory duct was accessed alongside a safety guidewire. After direct visual confirmation of the EDS, they were fragmented using laser lithotripsy and removed using a Zero Tip nitinol basket. The patient recovered well postoperatively with no complaints and remained asymptomatic. Conclusions: To date, other options have been described in literature such as transurethral resection of the ejaculatory duct (TURED), endoscopic laser-assisted resection of the ducts, and antegrade seminal vesical lavage. However, we present a more straightforward approach, which has the benefit of the EDS being fragmented and removed under direct vision without the complications of bladder neck and external sphincter injury often associated with TURED. Using an Ultra-Mini Nephroscope is a promising option for management of such cases. Patient Consent: Authors have received and archived patient consent for the video recording and publication in advance of video recording of procedure. No competing financial interests exist. Runtime of video: 5 mins, 42 secs