Transurethral Seminal Vesiculoscopy Research Articles

Efficacy of various surgical approaches in treating hematospermia using transurethral seminal vesiculoscopy

PurposeTo explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome.Materials and MethodsA retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy.ResultsThe total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010).ConclusionsThe Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.

Decreased Nrf2 protein level and low sperm quality in intractable spermatocystitis.

To investigate the molecular etiology of low sperm quality in patients with intractable spermatocystitis, spermatozoa samples from patients with persistent hematospermia undergoing transurethral seminal vesiculoscopy and healthy volunteers were utilized. Spermatozoa samples were collected from the seminal vesicles through transurethral seminal vesiculoscopy or by masturbation ejaculation. Sperm quality was analyzed by a WLJY-9000 color semen analysis system. Measurement of tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) in the seminal plasma was performed using enzyme-linked immunosorbent assay (ELISA). Measurement of H 2 O 2 in the seminal plasma was performed with a hydrogen peroxide kit. The protein levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and phosphorylated-Nrf2 (p-Nrf2) were measured by western blot analysis and immunofluorescence assays. Low sperm quality parameters and increased levels of inflammatory cytokines (TNFα, IL-6, and H 2 O 2 ) in the seminal plasma were detected among the semen samples from the patients with persistent hematospermia. Nrf2 and p-Nrf2 were strongly expressed in the nucleus and periphery of human sperm cells, according to the results of the immunofluorescence assays. The protein levels of Nrf2 and p-Nrf2 were significantly lower in the spermatozoa samples from patients with persistent hematospermia than in those from healthy volunteers with normal sperm motility. The results suggested that Nrf2 signaling might play a role in the low sperm quality of patients with intractable spermatocystitis.

Altered microbiota profile in seminal vesicles of men presenting with refractory hematospermia.

Currently, no recognized evidence is known about the bacterial communities found within seminal vesicles (SV) of men presenting with refractory hematospermia. Fifteen male patients with refractory hematospermia or anejaculation were enrolled, and 15 SV-Infection (SV-In) samples from SV with hemorrhage and/or stones, 11 SV-Control (SV-C) samples from SV with non-infection, and 14 Urine (Urine) samples from posterior urethra were obtained via transurethral seminal vesiculoscopy. Then the high-throughput 16S rRNA gene sequencing method was performed to characterize the microbiota profile. Finally, a total of 1535 operational taxonomic units (OTUs) were found, 1295 OTUs were shared across three groups, 7 OTUs, 45 OTUs, and 48 OTUs were unique to SV-C group, SV-In group, and Urine group, respectively. The 5 top bacterial phyla (mean relative abundance) in all samples were Firmicutes (52.08%), Bacteroidetes (21.69%), Proteobacteria (12.72%), Actinobacteria (9.64%), and Fusobacteria (1.62%), the 5 top bacterial genera in all samples were Bacteroides (9.13%), Lactobacillus (5.38%), Bifidobacterium (5.35%), Faecalibacterium (5.10%), and Allobaculum (3.34%), of which Bifidobacterium had the highest level in SV-C samples and had a significant difference (P < 0.05) across all groups. Differential analysis showed genera Leuconostoc and LachnospiraceaeFCS020group were identified as biomarkers in the SV-In microbiota. Altered microbiota composition in seminal vesicles is related to refractory hematospermia in men, and the distribution of genus Leuconostoc or LachnospiraceaeFCS020group within seminal vesicles may interact with hematospermia. This study provides clues for the diagnosis and treatment of this urologic disorder.

Intraoperative calculus or hemorrhage in transurethral seminal vesiculoscopy as a risk factor for recurrent hemospermia

We have summarized our experience regarding transurethral seminal vesiculoscopy (TUSV) and analyzed both its recurrence status and the risk factors for recurrence. From January 2010 to December 2020, 48 patients with intractable hemospermia received successful TUSV at Taichung Invalids General Hospital. Upon analysis of the intraoperative findings, the five-year disease-free Survival rates (DFS) were 74.1% in the no calculus group compared to 37.1% in the calculus group with a significant difference (log-rank p = 0.015), 75.0% in the no hemorrhage or no blood clot group compared to 43.2% in the hemorrhage or blood clot group with significant difference (log-rank p = 0.032). Univariate analysis showed intraoperative calculus (p = 0.040; HR: 2.94, 95% CI: 1.05-8.21) to be significantly associated with recurrence (p < 0.05). Patients with intractable hemospermia who were diagnosed with stones or blood clots found during TUSV experienced a higher rate of hemospermia recurrence.

Magnetic resonance imaging compared to ultrasound as the preferred method for diagnosing intractable haematospermia

We aimed to evaluate and compare the clinical diagnostic values of magnetic resonance imaging (MRI) and ultrasound in patients with intractable haematospermia. We performed a retrospective review of 23 patients with intractable haematospermia who were diagnosed with seminal vesicle haematocele and/or calculi by transurethral seminal vesiculoscopy (TSV). Patients’ demographics, disease durations, operative times, and MRI and transrectal ultrasound (TRUS) results were recorded. McNemar's test was used to compare the positive diagnostic rates of MRI and TRUS. All patients had undergone preoperative seminal vesicle MRI and TRUS to identify the aetiology of the haematospermia. The average age and disease duration were 39.3 years and 24.1 months, respectively. The mean operative time was 81.1 min. The positive result rates for MRI and TRUS were 95.7% (22/23) and 39.1% (9/23), respectively. Compared with TRUS, MRI had a significantly higher preoperative positive diagnostic rate (p < 0.01). These results suggest that MRI should be considered as a method for diagnosing intractable haematospermia in patients when TRUS findings are negative or inconclusive.

Transurethral seminal vesiculoscopy for intractable hematospermia: experience from 144 patients

Purposeto describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the area of the verumontanum, and to determine the safety of this procedure, especially in terms of postoperative complications.MethodsThis retrospective observational study enrolled 144 patients with intractable hematospermia from May 2011 and August 2019. A 4.5/6.5-Fr vesiculoscope was inserted into the seminal vesicle to deal with the positive findings. The solution of quinolones was used to rinse each seminal vesicle.ResultsIn this study, Transurethral seminal vesiculoscopy was successfully performed in 139 patients (96.53%). Hematospermia was alleviated or disappeared in 116 (80.56%) patients by less than half a year after surgery. Common intraoperative manifestations were hemorrhage, stones, utricle polyps and cysts. The surgical approach in our study were categorized into four types, including 24 (16.7%), 73 (50.7%), 42 (29.2%), and 5 (3.5%) cases in Type A (natural opening of the ejaculatory duct), B (trans-duct fenestration), C (trans-utricle fenestration), and D (not founded), respectively. Sexual function change was recorded in 12 patients of 111 patients, all by the method of trans-utricle fenestration, including 8 (7.21%), 3 (2.70%), and 1 (0.90%) patients in shorter intravaginal ejaculatory latency time, worse erection hardness and loss of orgasm, respectively.ConclusionTransurethral seminal vesiculoscopy is an effective and safe procedure for the management of hematospermia. The anatomy of the distal seminal tract should be understood more deeply and Wu’method (uncover-curtain method) needs to be promoted to verify its universality and safety. Besides, the complications of the function dysfunction should be discussed in the future in multi-center clinical trials.

Efficacy and feasibility of day surgery using transurethral seminal vesiculoscopy under caudal block anesthesia for intractable hemospermia.

BackgroundTransurethral seminal vesiculoscopy (TSV) is a safe and effective method for intractable hemospermia. It uses a natural cavity, is fast, involves little trauma, and boasts a low incidence of complications. Because uncontrollable penile erection during general anesthesia will severely influence the surgical operation or even damage the endoscope, spinal anesthesia was applied more on TSV. But spinal anesthesia extends the length of stay in the hospital and brings patients unnecessary discomfort. As the TSV is a quick recovery operation, we should think about a more suitable mode for these patients.MethodsA total of 141 patients received TSV between January 2015 and July 2019: 81 patients received day surgery under caudal block (group A), and 60 received inpatient surgery under spinal anesthesia (group B). Operative time, postoperative hospital stay, hemospermia remission rate, magnetic resonance imaging (MRI) remission rate are compared. Visual analog scale (VAS) scores of groups were taken and compared at 2 time points: when there was pain during surgery (T1) and at the end of surgery (T2). Surgical methods of two groups are the same.ResultsThe mean operative time of two groups are 34 min (group A) and 32 min (group B), and there was no statistical difference. Postoperative hemospermia remission rates are both 100% at 3 months, which at 6 months are 60% and 48%, and there was no statistical difference. MRI remission at 3 months are 72% and 57%, which has no statistical difference. Postoperative complications were mild in two groups like hematuria and dysuria which can relieve within one day, and there were no severe complications. Intraoperative pain was present in 18.5% (15/81) of group A. Their highest VAS score was 3 points, indicating mild pain, which did not influence the surgical process or postoperative recovery. The postoperative VAS scores were similar between the 2 groups. Group A did not require postoperative hospitalization, whereas the average postoperative hospitalization in group B was 2 days.ConclusionsSeminal vesiculoscopy can be performed as a day surgery under caudal block, which has obvious advantages in accelerating postoperative recovery and shortening the hospital stay.

Application of ultrasound-guided seminal vesicle radiography combining CT three-dimensional reconstruction technique in transurethral seminal vesiculoscopy.

For the treatment of ejaculatory duct obstruction, transurethral seminal vesiculoscopy (TSV) is the most common method, but the success rate is much lower than studies that have reported. So we developed a new ultrasound-guided seminal vesicle radiography (UGSVR) combining CT three-dimensional reconstruction (CT-TR) technique to improve the success rate of TSV. Between June 2018 and November 2019, 32 patients were enrolled and randomly assigned to two groups: experimental group (UGSvR combining CT-TR) and control group (standard evaluation). Baseline information, including age, smoking history and body mass index (BMI), was compared preoperatively. Surgical parameters included success rates (SR), surgical time (ST), catheter days (CD), length of hospital stays (HS) and complications were compared between groups. There were no statistically significant differences in baseline data between the two groups (all p>.05). There were no significant differences in the CD, HS and complications between the two groups (all p>.05), but the differences in ST and SR were statistically significant (p<.05). In conclusion, this new technique of UGSvR combining CT-TR was achieving a satisfactory increase in the success rate of TSV, while not increasing the incidence of complications, compared to normal evaluation before TSV operation.

Successful treatment of seminal vesicle calculi and prostatic utricle calculi by transurethral seminal vesiculoscopy.

To investigate the outcomes of transurethral seminal vesiculoscopy (TSV) for the treatment of seminal vesicle calculi (SVC), prostatic utricle calculi (PUC) and combination of them, a retrospective review on 27 patients with SVC and/or PUC who complained of intractable haematospermia was conducted. Patient demographics, disease duration, operation time, stone location and complications were recorded. The calculi in the seminal vesicle and/or prostatic utricle were removed by holmium laser lithotripsy and/or basket extraction. The stone composition was determined in 19 of 27 patients using Infrared spectroscopy. The average age and disease duration of patients were 39.4 years and 23.1 months respectively. The mean operative time was 78.5 min. We detected SVC, SVC and PUC, and PUC in 59.3% (16/27), 33.3% (9/27) and 7.4% (2/27) patients respectively. The stones were mainly composed of calcium oxalate dehydrate (COD), carbonate apatite (CA), COD and calcium oxalate monohydrate (COM), CA and magnesium ammonium phosphate, CA and COM, and COD and uric acid in 42.1% (8/19), 21.1% (4/19), 15.8% (3/19), 15.8% (3/19), 5.3% (1/19) and 5.3% (1/19) cases respectively. No intraoperative and post‐operative complications were noted. These results suggested that SVC and PUC can be diagnosed and treated using TSVs.

Guiding role of seminal tract anatomical study in transurethral seminal vesiculoscopy.

IntroductionThere have been problems with low qualification operator-related complications and failures of transurethral seminal vesiculoscopy (TSV) in China.AimTo study the guiding role of seminal tract anatomical study (STAS) in TSV.Material and methodsWe performed STAS to study the structure, morphology, duct trajectory, and anatomical relationships between the seminal vesicles and the adjacent tissue in pelvic specimens from 12 adult cadavers. Then the surgical effects and complications of 82 cases of TSV performed by 3 doctors were retrospectively studied to compare the difference between the two groups of before and after the anatomical study.ResultsThe anatomical studies of the 12 adult cadaveric pelvis specimens identified the lengths and widths of the right- and left-side seminal vesicles and tracts. The TSV can treat lesions located in the distal seminal tract and vesicle, but proximal lesions cannot be reached, which is an anatomical limitation of this technique. There were significant differences in the surgical times and the surgical validity rates between the 2 groups.ConclusionsOur anatomical study of the seminal tract and seminal vesicles is valuable for guiding TSV in clinical practice.

Etiology, Diagnosis, and Management of Seminal Vesicle Stones

Background/Aims: Seminal vesicle (SV) stones are a rare, and thus readily misdiagnosed condition in practice. Understanding the etiology, diagnosis, and management are crucial to guide a urologist's care, and are provided in this literature review. Methods: The inclusion criteria for the literature search, using the search engines MEDLINE® and PubMed was conducted using a combined query of “seminal vesicle stone” and the following keywords: calculi, hematospermia, calcification, and transrectal ultrasound (TRUS). Results: The etiology of SV stones is currently unknown where majority of the patients present with having painful ejaculation and hematospermia. However, clinicians have reported potential etiologies by categorization as an inflammatory or non-in-flammatory. A majority of the previous cases had shown multiple stones being present in the SV duct system that are typically diagnosed through radiological examination such as TRUS, MRI, or plain radiographs. Amongst the many imaging approaches, TRUS remains the primary imaging diagnoses of SV calculi. Transurethral seminal vesiculoscopy has shown to be used in an abundant of the case reports to be an ideal surgical approach for managing small SV stones. In regard to larger stones, a transperitoneal laparoscopic protocol is proper. Conclusion: The current imaging techniques have increased the case reports and diagnosis of SV calculi; however, more research is warranted for understanding the pathogenesis of the formation of SV stones. An optimal management of the extraction of SV stones depends on a number of factors such as size and location.

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

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.

An Innovative Technique of Transurethral Seminal Vesiculoscopy with Ultrasonic Lithotripter for Severe Persistent Hematospermia

Abstract Introduction: To introduce an innovative technique of transurethral seminal vesiculoscopy (TSV) with ultrasonic lithotripter for severe persistent hematospermia. Materials and Methods: From May 2012 to December 2015, totally 14 patients with severe persistent hematospermia underwent TSV with an ultrasonic lithotripter. For the patient with a positive urine solution microorganism culture, the sensitive antimicrobial therapy is administrated and the negative culture outcome is confirmed before the TSV procedure.1,2 Under general anesthesia, the patient is positioned in the standard lithotomy position. The 8F rigid ureteroscopy used as the seminal vesiculoscopy is inserted retrogradely, under the guidance of a 0.032-inch Zebra guidewire, through the utricular orifice at the verumontanum.3 After entering the lumen, the Zebra guidewire is further introduced through the ejaculatory duct orifice to guide the ureteroscopy entering seminal vesicle. If the orifice is masked behind a thin transparent membra...

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

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

Anatomical study of the seminal vesicle system for transurethral seminal vesiculoscopy.

Because of a general lack of knowledge regarding the precise anatomy of the seminal vesicle system, efforts to use transurethral seminal vesiculoscopy (TSV) are currently constrained. We investigated 26 normal adult male specimens. Contrast medium was injected into the seminal vesicle system in 18 specimens and the openings of the ejaculatory ducts were examined with an operating microscope. India ink was injected into the urethra in four specimens to investigate the function of the ejaculatory duct valve. Another four specimens were examined histologically to identify the anatomical relationships of the seminal vesicle system. We found that the openings of the ejaculatory ducts were covered by the ejaculatory duct valve, which could be classified into two types and acted as a one-way valve. The apex of the seminal colliculus together with the right and left openings of the ejaculatory ducts formed a shape resembling an isosceles triangle. This could be used to locate the openings of the ejaculatory ducts during TSV. The ejaculatory ducts can be classified into two types according to their course. During surgery, efforts must be made to protect the ejaculatory duct valve. During inspection or surgery, the second segment and the angles of the ejaculatory ducts, particularly in Type Ib and Type II cases, require particular attention. Clin. Anat. 32:244-252, 2019. © 2018 Wiley Periodicals, Inc.

AB071. Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases

BackgroundWe summarize our experience in transurethral seminal vesiculoscopy (TSV) for recurrent hemospermia by introducing surgical techniques, intra-operative findings and treatment outcomes.MethodsTSV was performed in 419 patients with an initial diagnosis of persistent hemospermia at Shanghai Changhai Hospital (Shanghai, China) from May 2007 to November 2015. TSV was successfully performed in 381 cases (90.9%). Hemospermia was alleviated or disappeared in 324 (85.0%) patients by 3 months after surgery. Common intra-operative manifestations were bleeding, obstruction or stenosis, mucosal lesions and calculus.ResultsEndoscopic presentation of the ejaculatory duct orifice and the verumontanum was categorized into 4 types, including 8 (1.9%), 32 (7.6%), 341 (81.4%) and 38 (9.1%) cases in types A, B, C and D, respectively. TSV is an effective and safe procedure in the management of seminal tract disorders.ConclusionsThis study may help other surgeons to become familiar with and improve this procedure. However, further multicenter clinical trials are warranted to validate these findings.

AB034. Advances in the diagnosis and treatment of ejaculatory duct obstructive diseases

Ejaculatory duct obstruction (EDO) is a cause of sperm dysfunction caused by obstructive factors in relation to vas deferens and epididymal obstruction. It is also one of the few male infertilities that can be cured by surgery, accounting for 1% to 5% of all male infertility causes. The causes of EDO can be divided into congenital and acquired factors. Congenital factors include loss of development, stenosis, Wolffian tube, Müllerian tube dysplasia, etc. Acquired factors include surgery, trauma, infection or inflammation, stones, tumors, etc. Congenital dysplasia is the most common cause of EDO when compared with acquired factors. EDO can be divided into one-sided EDO and bilateral EDO according to the anatomy of obstruction. According to the degree of obstruction, it can be divided into two types. Complete obstruction and incomplete obstruction. The clinical manifestations of complete obstruction are typical “four low” semen characteristics, that is, the amount of semen is small, there is no sperm, the pH of the seminal plasma is low, and the refined berry sugar is zero. Incomplete obstruction may have a variety of manifestations such as oligospermia, blood, pelvic pain. EDO has many clinical manifestations. Typically, typical semen exhibits a “four lows” feature. Transrectal ultrasound is an important imaging and surgical treatment for EDO screening. Magnetic resonance imaging provides high-resolution images of the reproductive system. Transurethral resection of the urethra (TURED) is a classic procedure for the treatment of EDO. The application of transurethral seminal vesiculoscopy has become a new trend of minimally invasive surgery in the treatment of EDO, and the latest flexible vesiculovasoscopy (FVV) or vasoscopy techniques may further improve the diagnosis and treatment of EDO.

535 A novel therapeutic method for azoospermia resulted from distal deferential obstruction

To evaluate the efficiency of the therapeutic method using seminal vesiculoscope with holmium laser to treat azoospermia resulted from distal deferential obstruction. We recruited 6 obstructive azoospermia (OA) patients from the Andrology Clinic. All cases were diagnosed as OA caused by distal deferential obstruction via 3 consecutive semen analyses, trans-rectal B-type ultrasound and pelvic MRI. Then we performed transurethral seminal vesiculoscopy for all patients, and treated the local lesions at the distal part of deferential duct using holmium laser. Cysts with calcification at the ejaculatory ducts were found in ultrasound images in 4 of 6 patients, and the other 2 cases suffered from the unexplained stenosis of vas deferens ampulla, which resulted in the obvious dilation of proximal part. During the operation, we firstly inserted the seminal vesiculoscope into the prostatic utricle, and then decorticated the cysts located at the ejaculatory duct or resected the scars at the ampulla of deferens duct using holmium laser. Motile sperms were found in 5 of 6 patients’ semens three months after the operations. Negative sperm in semen happened in only one patient with severe long stenosis of the vas deferens ampulla.

Transurethral seminal vesiculoscopy acts as a therapeutic investigation for intractable hemospermia: Step-by-step illustrations and single-surgeon experience.

To describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the seminal tract, and to report a single-surgeon experience with this procedure. A total of 38 consecutive patients with intractable macroscopic hemospermia were enrolled from January 2010 to July 2016. A 6/7.5-Fr semirigid ureteroscope was used to enter the seminal tract by one of these two approaches: through either a trans-ejaculatory duct opening or a trans-utricle fenestration. Patient characteristics and their preoperative and postoperative measurements were analyzed retrospectively. The success rate of transurethral seminal vesiculoscopy was 92.1%, whereas the approaching method in most patients was the trans-utricle fenestration (88.89%). A total of 34 (94.4%) transurethral seminal vesiculoscopy inspections ended with complete remission, even though nearly half of them (47.2%) only disclosed negative perioperative findings. The median period to complete remission was 4 weeks (interquartile range 4-6 weeks) after the procedure. Four patients had recurrent hemospermia, and the median time to recurrence was 21.5 (range 13-48.5) months. Transurethral seminal vesiculoscopy is a valuable diagnostic tool for intractable hemospermia, and also plays a therapeutic role by blocking the vicious cycle of stasis, calculi and seminal vesiculitis. More familiarity of the anatomy and enough practice would make the learning curve less steep.

V11-10 SURGICAL TECHNIQUES OF TRANSURETHRAL SEMINAL VESICULOSCOPY FOR INTRACTABLE HEMOSPERMIA

You have accessJournal of UrologyED, Infertility & Male Incontinence1 Apr 2018V11-10 SURGICAL TECHNIQUES OF TRANSURETHRAL SEMINAL VESICULOSCOPY FOR INTRACTABLE HEMOSPERMIA Ju-Chuan Hu and Chuan-Shu Chen Ju-Chuan HuJu-Chuan Hu More articles by this author and Chuan-Shu ChenChuan-Shu Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hemospermia is a fear-provoking symptom although it is usually benign and self-limiting. This study is aimed to review the anatomy of the seminal tract and provide a detailed description on the methodology of transurethral seminal vesiculoscopy (TUSV). The clinical experience based on a single surgeon was also reported. METHODS We used a 6/7.5 French semirigid ureteroscope which entered the seminal tract by one of the two approaches: through the opening of ejaculatory duct or transutrical fenestration. Patient characteristics and their preoperative and postoperative measurements were analyzed retrospectively. RESULTS Thirty-eight patients with intractable macroscopic hemospermia were enrolled consecutively from Jan 2010 to July 2016. The successful rate of TUSV was 92.1%. The transutrical fenestration method was the main approach of TUSV (88.9%). Seminal tract lithiasis was found in 44.4% cases and 94.4% patients reported complete remission of hemospermia. The median time to remission was 4 (Interquartile range, IQR 4-6) weeks. Although 11.76% patient reported recurrent hemospermia after median 21.5 (IQR 13-48.5) months, most of their hemospermia became less intractable and could be controlled by antibiotic only. CONCLUSIONS Transurethral seminal vesiculoscopy is a valuable diagnostic tool for intractable hemospermia and might play a therapeutic role by blocking the vicious cycle between stasis, calculi and seminal vesiculitis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1164-e1165 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ju-Chuan Hu More articles by this author Chuan-Shu Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...