Application of transurethral seminal vesiculoscopy in uroandrology / 中华男科学杂志

With the continuous improvement of living conditions, increasing attention is being drawn to the genitourinary health of males, which has boomed the development of uroandrology in recent years. Refractory hemospermia, infertility, and perineal pain are commonly seen in some male patients, and mainly relied on medical imaging for diagnosis in the past, which, however, has a high pseudopositive rate and cannot give an etiological explanation. Patients with these diseases often adopt conservative treatments such as medication and physiotherapy, often with poor prognosis, and those suffering frequent recurrence used to be treated by transurethral resection, laparoscopic surgery or open surgery, which are now rarely employed due to their high rate of postoperative complications, slow recovery, and easy recurrence. In recent years, transurethral seminal vesiculoscopy has gained a wide application in the diagnosis and treatment of the above-mentioned uroandrological diseases and shown its advantages of high clinical effectiveness and low incidence of complications. The review updates on the indications, methods, skills and clinical application of transurethral seminal vesiculoscopy.

Resolución laparoscópica de tumores de vesícula seminal: presentación de 2 casos y revisión de la literatura / Laparoscopic resolution of seminal vesicular tumors: 2 cases report and literature review

RESUMEN La patología tumoral de las vesículas seminales es extremadamente poco frecuente. Sólo existen reportes de series de casos que no logran ser más de 150 en todo el mundo. Por lo mismo, no existen pautas de recomendación para el diagnóstico y tratamiento. A propósito de 2 casos de tumores de vesículas seminales ocurridos en un período de 12 meses en nuestro centro, hemos decidido realizar una revisión de la literatura actual sobre el estudio y manejo de esta patología poco frecuente. La sintomatología es inespecífica, y su diagnóstico comprende una combinación de test sanguíneos, imagenológicos e histopatológicos en su mayoría para descartar otras neoplasias. El tratamiento es multimodal el cual incluye resección quirúrgica donde la vía laparoscópica es el patrón de oro, asociado a adyuvancia con hormonoterapia y/o radioterapia. Su pronóstico es pobre debido al diagnóstico en etapas avanzadas, por lo que se requiere un alto índice de sospecha diagnóstica para lograr realizar un tratamiento oportuno.(AU)

Abstract The tumor pathology of the seminal vesicles is extremely rare. There are only reports of series of cases that fail to be more than 150 worldwide. For this reason, there are no recommendation guidelines for diagnosis and treatment. With regard to 2 cases of seminal vesicle tumors that occurred in a period of 12 months in our center, we decided to review the current literature on the study and management of this rare pathology. The symptomatology is non-specific, and its diagnosis includes a combination of blood, imaging and histopathological tests, mostly to rule out other neoplasms. The treatment is multimodal, which includes surgical resection where the laparoscopic approach is the gold standard, associated with adjuvance with hormone therapy and / or radiotherapy. Its prognosis is poor due to the diagnosis in advanced stages, which is why a high index of diagnostic suspicion is required to achieve an opportune treatment.(AU)

The feasibility and safety of applying all-seeing needle in transurethral seminal vesiculoscopy / 中华泌尿外科杂志

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.

Transurethral seminal vesiculoscopy in the treatment of refractory hemospermia / 中华泌尿外科杂志

Objective To discuss the clinical effects of transurethral seminal vesiculoscopy in refractory hemospermia caused by seminal vesicle diseases.Methods The clinical data of 50 patients suffered from refractory hemospermia caused by seminal vesicle gland diseases were retrospectively analyzed from February 2012 to February 2014.Patients' age varied from 25 to 54 years old,mean (39.2 ± 9.2) years.The course of disease was (7.44 ± 2.6) months.There were 24 seminal vesiculitis,10 seminal ducts obstruction disease,and 16 seminal vesicle calculi disease.According to patients' priority,the patients were divided into surgical treatment group and conservative treatment group.In surgical group,there were 38 patients with age of (38.9 ± 8.8) years old,and the course of disease was (7.5 ± 2.5) months.There were 18 seminal vesiculitis,8 seminal ducts obstruction,and 12 seminal vesicle calculi.Whereas in conservative treatment group,there were 12 patients,with age of (40.2 ± 10.5) years old,and the course of disease was (7.3 ±2.9) months.Among them,there were 6 seminal vesiculitis,2 seminal ducts obstruction,and 4 seminal vesicle calculi.There was no significant difference between the two groups in patients age,course of disease and constitution of disease.The clinical data derived from the two treatment groups including the white blood cell counts (WBC) and red blood cell counts (RBC) in the seminal fluid,hematospermia rate,quality of life score,cure rate and improvement rate before and after the treatment were analysed.Results 1,3,6 months and 1 year after treatment,all observation indexes in the two groups had been ameliorated and had significant difference compared with those before treatment including WBC and RBC in the seminal fluid,hematospermia rate and quality of life score.No operative complications occurred in conservative treatment group.While a patient in surgical treatment group suffered from infection and recovered after levofloxacin treatment for a day.Six months after two kinds of treatment,in surgical treatment group,the cure rate was 55.2％,and the improvement rate was 36.8％.In the meanwhile,in conservative treatment group,the cure rate and the improvement rate were both 25.0％.A year after two different treatment,in surgical treatment group,the cure rate was 60.5％,the improvement rate was 34.2％.However,in conservative treatment group,the cure rate and improvement rate were both 8.3％.The effective rate of surgical group was much higher than that of conservative treatment group and the difference were significant.Conclusions Both transurethral seminal vesiculoscopy and conservative treatment have certain effects in relieving hemospermia.The transurethral seminal vesiculoscopy has obvious advantages over conservative treatment in improving the clinical effects of hemospermia after long duration.It could be used as a good supplement when medication fail.

Transurethral seminal vesiculoscopy for recurrent hemospermia: Experience from 419 cases / 亚洲男科学杂志(英文版)

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.

Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy

ABSTRACT Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients. Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale. Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001). On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001). The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001). Conclusions: Prostatic calculi are an independent predictive factor of severe hematospermia after TRUSBx on the basis of multivariate analysis, but don't affect the positive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity.

Treatment of hemospermia with transprostatic utricle seminal vesiculoscopy / 中国医师进修杂志

Objective To determine the feasibility and safety of transprostatic utricle seminal vesiculoscopy in the treatment of hemospermia. Methods Totally 11 patients with hemospermia, mean age of (46.6 ± 3.5) years, ranging from 38 to 68 years, for 3 months admitted from September 2012 to August 2015 were enrolled, Their main manifestations were hemospermia. Painful ejaculation was observed in 7 patients, and perineal and testicular pain occured in 4 patients. They all underwent transprostatic utricle seminal vesiculoscopy, and then were followed up for 3 to 6 months. Results Ten patients were operated successfully, but 1 patient failed. The operation revealed that the causes of hemospermia were seminal vesiculitis in 8 cases, seminal vesiculitis accompanied with seminal calculi in 2 cases, and ejaculatory duct cyst in 1 case. Operation time was (29.2 ± 3.2) min ( ranging from 25 to 37 min) , and hospital stay was 2 d ( from 2 to 4 d). Hemospermia disappeared in 10 patients within 1 month of surgery, and hemospermia recurrence was observed in 1 patient within 6 months. The patient was treated with transprostatic utricle Holmium laser incision, then hemospermia was dispeared,Two cases of postoperative epididymitis were cured after one week of antibiotic treatment. Conclusions Seminal vesiculoscopy is a safe and effective to treat hemaospermia.

Hemospermia due to Multiple Stones in the Enlarged Prostatic Utricle

Cystic enlargement of prostatic utricle, a vestigial remnant of mullerian duct, is a rare condition in males. The prostatic utricle distends with urine during voiding and then passively drains. Poor emptying leads to urine retention and stasis. Stone formation may result from obstruction. Patients present clinically with chronic urinary tract infection, hematuria, urethral discharge, epididymitis, and voiding dysfunction. We present a case of multiple stones in the enlarged prostatic utricle associated with hemospermia.

Clinical observation on Ningmitai Capsule for treatment of hemospermia caused by vesiculitis / 中草药

Objective: To investigate the effects of Ningmitai Capsule in the treatment of hemospermia caused by vesiculitis. Methods: A total of 105 cases of male patients with diagnosis of hemospermia caused by vesiculitis were randomly divided into Ningmitai Capsule treatment group and antibiotic treatment group. Both groups were respectively given Ningmitai Capsule and Levofloxacin Tablets for 4 weeks. Hemospermia changes and clinical symptom improvement were adopted as a curative effect judgment standard, and changes were observed before the treatment and 2 weeks after the treatment stopped. Results: The total effective rate in Ningmitai Capsule group was 77.0%, and the total effective rate in the antibiotics group was 61.4%. Conclusion: Ningmitai Capsule used for the treatment of hemospermia caused by vesiculitis has obtained satisfactory results, and it has the advantage of mild drug side effects, better tolerance, and good economical efficiency.

Current Status of 5alpha-Reductase Inhibitors in Prostate Disease Management

The key enzyme in the androgen synthesis and androgen receptor pathways is 5alpha-reductase (5-AR), which occurs as three isoenzymes. Types I and II 5-ARs the most important clinically, and two different 5-AR inhibitors (5-ARIs), finasteride and dutasteride, have been developed. Several urology associations have recommended and upgraded the use of 5-ARIs for an enlarged prostate with lower urinary tract symptoms. In the Prostate Cancer Prevention Trial and the Reduction by Dutasteride of Prostate Cancer Events Trial, 5-ARIs reduced the incidence of low-grade prostate cancer. However, despite the documented reductions in the overall incidence of prostate cancer, 5-ARIs are at the center of a dispute. The American Society of Clinical Oncology (ASCO) and the American Urology Association (AUA) presented clinical guidelines for the use of 5-ARIs for chemoprevention of prostate cancer in 2008. However, ASCO/AUA has eliminated these from the main "Clinical Guidelines" in 2012, because the U.S. Food and Drug Administration denied a supplemental New Drug Application for the use of dutasteride for prostate cancer chemoprevention. The 5-ARIs can also be used to manage hemospermia and prostatic hematuria, and to prevent intraoperative bleeding, although there is insufficient evidence for a standard strategy. This review summarizes the current use of 5-ARIs for prostate disease, including benign prostate hyperplasia, prostate cancer, prostate-related bleeding, and hemospermia.

Clinical Significance of Transrectal Ultrasonography and Efficacy of Dutasteride Treatment in Patients with Hemospermia / 대한남성과학회지

PURPOSE: The aims of this study were to investigate the clinical significance of transrectal ultrasonography (TRUS) and the efficacy of dutasteride (5alpha-reductase inhibitor) in patients with hemospermia. MATERIALS AND METHODS: From January 2005 to December 2008, 60 patients with hemospermia were enrolled in the study. All patients underwent a digital rectal examination and TRUS; serum prostate specific antigen was also measured. The management of hemospermia was one of the following: watchful waiting, dutasteride treatment, or antibiotics with dutasteride. RESULTS: Thirty-four patients (56.7%) had positive findings on TRUS. There were 16 cases (26.7%) of prostate calcification, 13 cases (21.7%) of ejaculatory duct cyst, 3 cases (5%) of ejaculatory duct calcification, a case of seminal vesicle inflammation, and a case of ejaculatory duct dilation. Dutasteride treatment resulted in improvement of symptoms in 87.9% (29/33) of the cases, whereas treatment with antibiotics or antibiotics with dutasteride resulted in a 100% (6/6) success rate. However, among 14 watchful waiting patients, only 3 patients (21.4%) showed an improvement of symptoms. CONCLUSIONS: This study showed that TRUS is an easy and effective method for the assessment of hemospermia, and also revealed that dutasteride could be a useful agent in the treatment of hemospermia.

Clinical research of Finasteride in treating hemospermia 30 cases / 中华内分泌外科杂志

Objective To evaluate the efficiency of Finasteride in treating inflammatory hemospermia and approach the mechanism of action. Methods 56 cases of hemospermia were randomly divided into two groups. The experimental group (n = 30) was treated with Finasteride combined with antibiotic for 1 month, while the control group(n=26) was treated only with antibiotics for 1 month. The expression of VEGF in sperma was de-tected by enzyme linked immunosorbent assay (ELISA) in pretherapy and post-treatment. Results Hemospermia disappeared in 28 cases of experiment group(28/30, 93.3%) and in 17 cases of control group(15/30,57.7%),with significant difference. The expression of VEGF degrade in post-treatment. Conclusions Hemospermia can be treated more effective with finastefide combined with antibiotics. The mechanisms may be associated with Finas-teride can reduce VEGF synthesis and inhibit the microvascular formation.

Effectiveness of Transurethral Coagulation and Incision of Ejaculatory Duct for Hematospermia Caused by Ejaculatory Duct Cyst and Obstruction

PURPOSE: To evaluate the usefulness and effectiveness of transurethral coagulation and incision of the ejaculatory duct for hematospermia caused by ejaculatory duct cyst and obstruction. MATERIALS AND METHODS: Twenty-six patients with hematospermia were enrolled. Ejaculatory duct cyst or obstruction was diagnosed by transrectal ultrasound or MRI, revealing seminal vesicle hypertrophy and cystic dilated ejaculatory ducts. One patient had hematospermia associated with infertility. The mean age of the patients and their duration of symptoms were 42.7 years (range, 25-67 years) and 16 months (range, 1-60 months), respectively. All patients underwent transurethral management for treatment of their ejaculatory duct obstruction in the form of incision and coagulation of the ejaculatory duct. We used a 9.5 Fr rigid ureteroscope (Stortz(R), Germany) and a Bugbee electrode. Patients were followed for more than 3 months after the procedure. RESULTS: All patients reported improvement of hematospermia and disappearance of midline cysts, except for one patient. The one case, ureteroscope failed to pass through verumontanum. A ejaculatory duct cyst was found in 18 cases. Calculi were present in the seminal vesicle and ejaculatory ducts in 7 patients and were removed with endoscopic instruments. One infertile patient regained reproductive ability after the procedure. Postoperative complications, such as epididymitis, orchitis, or retrograde ejaculation were not observed. CONCLUSIONS: Transurethral incision and coagulation was a safe and effective treatment option for hematospermia caused by ejaculatory duct obstruction and is considered to be a successful treatment option for infertility secondary to ejaculatory duct obstruction.

Endorectal magnetic resonance imaging in persistent hemospermia

OBJECTIVE: To present the spectrum of abnormalities found at endorectal magnetic resonance imaging (E-MRI), in patients with persistent hemospermia. MATERIALS AND METHODS: A review of E-MRI findings observed in 86 patients with persistent hemospermia was performed and results compared with those reported in the literature. Follow-up was possible in 37 of 86 (43 percent) patients with hemospermia. RESULTS: E-MRI showed abnormal findings in 52 of 86 (60 percent) patients with hemospermia. These findings were: a) hemorrhagic seminal vesicle and ejaculatory duct, isolated (n = 11 or 21 percent) or associated with complicated midline prostatic cyst (n = 10 or 19.0 percent); b) hemorrhagic chronic seminal vesiculitis, isolated (n = 14 or 27 percent) or associated with calculi within dilated ejaculatory ducts (n = 2 or 4 percent); c) hemorrhagic seminal vesicle associated with calculi within dilated ejaculatory duct (n = 4 or 7.7 percent) or within seminal vesicle (n = 4 or 7.7 percent); d) non-complicated midline prostatic cyst (n = 6 or 11.5 percent); and e) prostate cancer (n = 1 or 2 percent). Successful treatment was more frequent in patients with chronic inflammatory and/or obstructive abnormalities. CONCLUSION: E-MRI should be considered the modality of choice, for the evaluation of patients with persistent hemospermia.

HUANG Hai-long’s clinical experience in treating hysteromyoma, infertility and hemospermia / 中华中医药杂志

This article introduced HUANG Hai-long’s clinical experience in treating miscellaneous diseases, such as hysteromyoma, secondary infertility and hemospermia, and introduced the therapeutical effect of hualiu decoction, which was one of HUANG Hai-long’s empirical formula, and explained the clinical experience in treating hemospermia by the method of applying clearing after tonifying.

Treatment of the Hemospermia / 대한비뇨기과학회지

To evaluate the etiology and treatment of options in patients with hemospermia, we retrospectively reviewed 21 patients who had both transrectal ultrasound and MRI and have been followed for more than 6 months after initiation of treatment. Mean age was 40 years (range 20 - 50 years) with duration of infliction being 24 months (range 1 week to 16 years). Among the 14 patients with prostatic cyst, 9 patients underwent transurethral unroofing (TUUR) of cyst. All 9 patients were completely cured, but one patient developed postoperative epididymitis. Among the 6 patients with prostatitis, hemospermia was resolved in 4 patients after mean treatment of 12 weeks with antibiotics. In DES (Diethylstilbestrol) group, 50 % showed resolution of symptoms among 6 patients after 4 weeks of treatment, and two patients complained breast discomfort which were developed after medication. In conclusion, the antibiotic treatment is advisable in hemospermia patients with prostatitis. Prostatic cystic lesion is believed to be a factor in hemospermia, thus TUUR of cyst wall and removal of stone and hematoma in cyst can be a viable option.

The findings of transrectal ultrasonography in evaluation of organic hemospermia / 대한비뇨기과학회지

Hemospermia is a common urologic problem that can be caused by diverse pathologic entities, including inflammatory and neoplastic disorders of the seminal tract. Transrectal ultrasonography provides excellent anatomic detail of pathologic changes in the seminal vesicle and ejaculatory duct. Morphological change of the seminal tract of patient with hemospermia was determined by means or transrectal sonography on 16 patients. The 14 patients (88%) had positive sonographic findings, Abnormalities detected included 5 cases of seminal vesicle stones, 2 cases of dilatated seminal vesicles, 3 cases of ejaculatory duct stones. 2 cases of ejaculatory duct cysts, 1 case of seminal vesicle stone and ejaculatory duct stone, 1 case of Mullerian duct cyst. Our result indicate that transrectal ultrasound is effective in studing in patient with organic hemospermia.