V07-10 SEMINAL VESICULOSCOPY FOR DIAGNOSIS AND MANAGEMENT OF HEMATOSPERMIA

Abstract

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-10 SEMINAL VESICULOSCOPY FOR DIAGNOSIS AND MANAGEMENT OF HEMATOSPERMIA Aaron Brant, Nahid Punjani, Christopher Gaffney, Jonathan Fainberg, and James Kashanian Aaron BrantAaron Brant More articles by this author , Nahid PunjaniNahid Punjani More articles by this author , Christopher GaffneyChristopher Gaffney More articles by this author , Jonathan FainbergJonathan Fainberg More articles by this author , and James KashanianJames Kashanian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hematospermia is an uncommon urologic complaint but a cause of significant distress in affected patients. It is associated with bothersome symptoms such as dysorgasmia and chronic pelvic pain. First line treatment options include antibiotics, non-steroidal anti-inflammatory drugs (NSAIDS), alpha blockers, and 5-alpha reductase inhibitors. For patients with refractory symptoms, operative intervention with transurethral resection of ejaculatory ducts (TURED) and seminal vesiculoscopy has been described. METHODS: We provide a step-by-step description of seminal vesiculoscopy, TURED, and seminal vesicle (SV) balloon dilation in a 28-year old male presenting with five years of refractory hematospermia and dysorgasmia. He had failed treatment with antibiotics, NSAIDS, tamsulosin, and finasteride. His infectious and sexually-transmitted infection work-up was normal. His semen analysis was notable for 16% motility, 3.4 million WBC/mL, and cloudy brown color. Imaging with ultrasound and MRI revealed right SV dilation and clot in the left SV. RESULTS: After a normal cystoscopy, the verumontanum was identified, and the left ejaculatory duct was successfully cannulated with a 5-french open-ended catheter over a 0.014-inch micro-guidewire. Transrectal ultrasound was used to confirm correct placement. After dilation with a percutaneous transluminal angioplasty balloon dilator, the left seminal vesicle was entered under direct vision with a 4.5 french semi-rigid ureteroscope. Significant debris were noted and removed via irrigation through a luer-lock syringe. Both ejaculatory ducts were resected using a monopolar loop. The right SV was then cannulated, dilated, and entered under direct vision. Blood clot and debris were removed via irrigation. There were no post-operative complications. At six- and twelve-months follow-up, the patient reported significant improvement in dysorgasmia and complete resolution of hematospermia. CONCLUSIONS: Seminal vesiculoscopy with transurethral resection of ejaculatory ducts and balloon dilation is an effective procedure for hematospermia refractory to medical therapy in the appropriately selected patient. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e554 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Nahid Punjani More articles by this author Christopher Gaffney More articles by this author Jonathan Fainberg More articles by this author James Kashanian More articles by this author Expand All Advertisement PDF downloadLoading ...