精囊镜检诊治顽固性血精

Transurethral seminal vesiculoscopy with a ureteroscope for diagnosis and management of persistent hematospermia

目的探讨经尿道精囊镜检诊治顽固性血精的临床应用价值。方法回顾性分析我院自2008年9月以来开展经尿道精囊镜检诊治8例顽固性血精患者的临床资料,结合文献复习顽固性血精的治疗方法。年龄26～55岁,平均42岁,血精病程6～48个月,平均12个月,药物和物理治疗无效。采用7F输尿管硬镜行经尿道精囊镜检。结果 8例精囊镜检手术均成功,手术时间分别为20～75min,平均35min。精囊镜检示慢性炎症5例,精囊结石2例,射精管梗阻扩张1例。无尿道和精囊损伤等并发症。术后随访时间3～24个月,7例患者血精症状消失,1例术后9个月再发血精。结论经尿道精囊镜检操作简单,创伤小,可作为顽固性血精的有效诊治方法之一。

Objectives To describe a novel technique of transurethral seminal vesiculoscopy with a ureteroscope for diagnosis and management of persistent hematospermia.Methods The clinical data of 8 cases with persistent hematospermia underwent transurethral seminal vesiculoscopy to diagnosis and treat it from 2008 Sep in our department were analyzed retrospectively and literatures were reviewed.The age ranged from 26 to 55 years（mean 42）.Eight patients with a course of the hematospermia 6 to 48 months（mean 12） did not improve with medication within a period 6 months.The ejaculatory duct and seminal vesicle were observed under direct vision through the distal seminal tracts using a 7F rigid ureteroscope.Results Transurethral seminal vesiculoscopy was successfully performed in the 8 cases and the mean operative time was 35 min（range 20-75）.Eight patients were confirmed by transurethral seminal vesiculoscopy（five seminal vesiculitis,two seminal stone and one vas deferens obstruction）.There were no complications including injury of urethra and seminal vesicle and postoperative discomforts in the perineal region.The mean follow-up period was 10 months（range 3-24）.Hematospermia in 7 cases disappeared and 1 patient recurred in 9 months after receiving transurethral seminal vesiculoscopy.Conclusions Transurethral seminal vesiculoscopy could be performed easily using slender rigid ureteroscopy with few complications and was an effective therapeutic approach to persistent hematospermia.