ABSTRACT
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.
ABSTRACT
Objective To improve the diagnosis and management of closed renal trauma,and to reduce the rate of nephrectomy. Methods A total of 189 cases (146 men and 43 women; mean age,38 years) of closed renal trauma were retrospectively studied. A variety of examinations, including urinary analysis, B-ultrasonography, intravenous urography( IVU) and CT,were used for the diagnosis in these patients. Among them,closed renal trauma was accompanied by celiac viscera injury in 27 cases,by encephalic injury in 5, by fractures of spine and limbs in 13,and by compound trauma and shock in 3. Of the 189 cases, 156 were treated with conservative therapy, including 3 of spleen rupture,2 of encephalic injury,7 of fracture of spine and limbs;27 cases were treated with operation, including 15 with kidney repair,5 with partial nephrectomy, 7 with nephrectomy;3 cases were treated with selective renal artery embolization. Results Three patients with severe closed renal trauma died of compound trauma and shock soon after admission,and the other 186 patients recovered. Of them, 102 cases were followed up from 3 months to 8 years. Among patients undergoing conservative treatment renal hypertension occurred in 3 cases, urinoma in 1 , kidney atrophy in 1 and local hydronephrosis in 1. In patients undergoing surgery or selective kidney artery embolization, no subsequent complication occurred. Conclusions CT scan can provide a major basis for the diagnosis and treatment choice as well as early detection of urinoma of closed renal trauma. For closed renal trauma below grade IV ,conservative treatment is the better option.