Transurethral seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle stones

Background Seminal vesicle stones are one of the main causes of persistent hemospermia. Treatment requires removal of the stone, generally through open vesiculectomy. The purpose of this study was to apply a transurethral seminal vesiculoscopy for diagnosis and treatment of the seminal vesicle stones with an ureteroscope. We assessed whether this transurethral endoscopic technique is feasible and effective in the diagnosis and treatment of the seminal vesicle stones with intractable hemospermia. Methods Totally 12 patients with intractable hemospermia underwent transurethral seminal vesiculoscopy through the distal seminal tracts using a 7.3-French rigid ureteroscope. Age of patients ranged from 25 to 57 years （mean age （43.7±10.5） years）. The patients＇ symptoms ranged in duration from 4 to 180 months （mean duration （47.8±45.3） months）. All patients underwent transrectal ultrasonography, pelvic computed tomography or magnetic resonance imaging before the operation. Positive imaging findings were observed in patients with seminal vesicle stones and dilated seminal vesicle size. A 7.3-French rigid ureteroscope entered the lumen of the verumontanum, and then the seminal vesicle under direct vision. Seminal vesicle stones were found unilaterally in 11 cases and bilaterally in one case. Results All 12 patients successfully underwent transurethral seminal vesiculoscopy. The seminal vesicle interior with single or multiple yellowish stones ranging from 1 to 5 mm in diameter was clearly visible. All the stones were easily fragmented and endoscopically removed using a grasper. The operative time was 30 to 120 minutes （mean （49±22） minutes）. The mean follow-up period was （6.9±3.0） months （range 3-13 months）. Symptoms of hemospermia disappeared after one month in 10 patients and after three months in two patients. Three patients with painful ejaculation could completely be relieved postoperation. There was also improvement in one patient with erectile dysfunction. There were no postoperative complications. Conclusions Transurethral seminal vesiculoscopy is safe and effective in the diagnosis and treatment of seminal vesicle stones. This endoscopic technique can be performed with minimal complications.

Transurethral seminal vesiculoscopy for recurrent hemospermia： experience from 419 cases

We summarized our experience in transurethral seminal vesiculoscopy （TSV） for recurrent hemospermia by introducing surgical techniques, intraoperative findings, and treatment outcomes. TSV 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 intraoperative manifestations were bleeding, obstruction or stenosis, mucosal lesions, and calculus. Endoscopic presentation of the ejaculatory duct orifice and the verumontanum was categorized into four 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. This study may help other surgeons to become familiar with and improve this procedure. However, further multicentric clinical trials are warranted to validate these findings.

Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: a single-center, prospective, observational study

This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜time transrectal ultrasonography(TRUS)in managing persistent hematospermia.A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center,prospective,observational study.The median follow-up period was 36.5(range:8.0-97.5)months.TSV was successfully performed in 272(96.8%)patients.The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum.Seven(2.6%),74(27.2%),64(23.5%),and 127(46.7%)patients had Types I(through the ejaculatory duct in the urethra),II(through the ejaculatory duct in the prostatic utricle),III(transutricular fenestration through a thin membrane),and IV(real-time transrectal ultrasound-guided transutricular fenestration)approach,respectively.In patients who successfully underwent surgery,bleeding occurred in the seminal vesicle in 249(91.5%)patients.Seminal vesiculitis,calculus in the prostatic utricle,calculus in the ejaculatory duct,calculus in the seminal vesicle,prostatic utricle cysts,and seminal vesicle cysts were observed in 213(78.3%),96(35.3%),22(8.1%),81(29.8%),25(9.2%),and 11(4.0%)patients,respectively.Hematospermia was alleviated or disappeared in 244(89.7%)patients 12 months after surgery.Fifteen patients had recurrent hematospermia,and the median time to recurrence was 7.5(range:2.0-18.5)months.TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

精囊镜在顽固性和复发性血精中的诊治效果-单中心经验总结

The diagnosis and treatment of hemospermia presents significant difficulty, especially if it persists or recurs. In this retrospective study, we assessed whether transurethral seminal vesiculoscopy is feasible and effective in the diagnosis and treatment of hemospermia. To address this complex condition, we report our experience in a population of patients treated with transurethral seminal vesiculoscopy. From February 2006 to July 2008, 72 hemospermic patients underwent transurethral seminal vesiculoscopy examination and treatment at our urology center. Transurethral seminal vesiculoscopy was performed by a 7-F or 8-F rigid ureteroscope. The endoscopic procedure was conducted through the normal anatomic route of the seminal tracts. In this series, the mean follow-up period was 21.7 months. Definite diagnosis was made for 93.1% patients, and 94.4% patients were cured or showed a decrease in their symptoms. Postoperative complications were not observed in the study. Our study proves that transurethral seminal vesiculoscopy is effective in the diagnosis and treatment of hemospermia with minimal complication.