ABSTRACT
Seminal vesiculoscopy is a new technology in uro-andrology developed in recent 10 years, which is a set of clinical operational techniques for observing the ejaculatory duct, seminal vesicle, ampullar region of the vas deferens and their surrounding structure, determining the cause, location and degree of the disease, and accomplishing such treatment procedures as irrigation, resection, incision, fulguration, hemostasis, expansion, drainage, and removal of hematocele, stones or obstruction in the distal seminal duct region. Therefore, it is not only an etiologically diagnostic technique, but also a minimally invasive surgical approach to the management of common diseases of the distal seminal duct region. Seminal vesiculoscopy has irreplaceable advantages of safety, effectiveness, minimal invasiveness, rapid recovery, and few complications.
Subject(s)
Humans , Male , Calculi , Diagnostic Imaging , General Surgery , Drainage , Ejaculatory Ducts , Diagnostic Imaging , Endoscopy , Methods , Genital Diseases, Male , Diagnostic Imaging , General Surgery , Hematocele , Diagnostic Imaging , General Surgery , Minimally Invasive Surgical Procedures , Seminal Vesicles , Diagnostic Imaging , Vas Deferens , Diagnostic ImagingABSTRACT
Ejaculatory duct obstruction (EDO) is one of the obstructive factors for 1－5% of all cases of male infertility and it is, however, surgically correctable. Congenital developmental abnormality is a most common cause of EDO. The clinical manifestations of EDO are varied, typically with the decline of four semen parameters. Transrectal ultrasonography is an important imaging method for the diagnosis of EDO and guidance in its surgery. MRI provides high-resolution images of the reproductive system as evidence. Transurethral resection of the ejaculatory duct (TURED) is a classical operation, 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.
Subject(s)
Adult , Humans , Male , Ejaculatory Ducts , Diagnostic Imaging , General Surgery , Genital Diseases, Male , Diagnostic Imaging , General Surgery , Infertility, Male , Magnetic Resonance Imaging , Semen , Ultrasonography , Vas Deferens , Diagnostic ImagingABSTRACT
<p><b>Objective</b>To summarize the experience in the diagnosis and treatment of refractory hematospermia and ejaculatory duct obstruction by seminal vesiculoscopy.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data about 42 cases of refractory hematospermia and 6 cases of ejaculatory duct obstruction with azoospermia. We investigated the diagnosis, treatment, and prognosis of the diseases.</p><p><b>RESULTS</b>All the patients underwent pelvic MRI and seminal vesiculoscopy. MRI for the 42 refractory hematospermia patients showed that 21 (50.0%) had cystic dilatation in the uni- or bilateral seminal vesicles, 25 (59.5%) had abnormal internal signal intensity in the uni- or bilateral seminal vesicles, 12 (28.6%) had both the problems above, and 4 (9.52%) had no obvious abnormality in the seminal vesicle area. The bilateral seminal vesicles were <1 cm in width in 3 of the 6 cases of ejaculatory duct obstruction, and obviously enlarged in the other 3, but without abnormal internal signals. No recurrence was found during the 3－36 months follow-up.</p><p><b>CONCLUSIONS</b>The history and physical examination play important roles in the diagnosis of refractory hemospermia, and MRI is more valuable than TRUS in the diagnosis of seminal vesicle diseases. Seminal vesiculoscopy is an effective option for the management of persistent hematospermia and ejaculatory duct obstruction.</p>
Subject(s)
Humans , Male , Azoospermia , Ejaculatory Ducts , Diagnostic Imaging , Endoscopy , Methods , Hemospermia , Diagnostic Imaging , Magnetic Resonance Imaging , Recurrence , Retrospective Studies , Seminal Vesicles , Diagnostic ImagingABSTRACT
nosis and treatment of EDO.
ABSTRACT
The diagnosis of ejaculatory duct obstruction(EDO) may be suspected on clinical grounds from the characteristic seminal analysis and is being confirmed by vasoseminal vesiculography. Through the analysis of our experienced cases, we defined the new characteristics of EDO in semen analysis and we investigated the role of TRUS in diagnosing this entity. We analyzed 23 EDO patients we experienced during the last 5 years. All cases were diagnosed by vasoseminal vesiculography. In last 16 patients, transrectal ultrasonography(TRUS) was performed before vasoseminal vesiculography and 15 patients(94% ) were suspected to be EDO. The cause of EDO were identified as midline cyst in 7 patients, Wolffian malformation in 4, previous genitourinary infection in 5, and unknown causes in 7. We have treated 21 patients. Fourteen patients were treated by transurethral resection (TUR), 5 patients by forceful lavage through vasotomy site, 2 patients by transseptal vasovasostomy. Eight (57%) of 14 patients treated by TUR achieved an improvement in semen volume and/or semen quality and 3 patients( 10% ) produced pregnancy. Six(86%) of 7 patients caused by midline cyst achieved improvement in semen parameters and 3 patients(43% ) produced pregnancy. Overall, ten of 21(48%) patients achieved improvement in semen characteristics, 3 patients(12%) produced pregnancy. Among our cases, six patients presented with a subtle and mild abnormalities in seminal fluid Their sperm density was above 10xl0'/ml while ejaculated volume was low to normal. Their sperm motility was consistently diminished(less than 35%) and semen fructose was low(less than 140). TRUS enabled to detect midline cyst or seminal vesicle dilatation in these partial EDO cases before vasoseminal vesiculography. Based on our experience of EDO we suggest that TRUS is the initial diagnostic procedure if infertile patients were suspected as EDO according to semen parameters. We suggest that if semen fructose was low in the athenospermic patient who has high sperm density( >0.000001/ml), TRUS should be performed.
Subject(s)
Humans , Male , Pregnancy , Diagnosis , Dilatation , Ejaculatory Ducts , Fructose , Infertility, Male , Semen , Semen Analysis , Seminal Vesicles , Sperm Motility , Spermatozoa , Therapeutic Irrigation , VasovasostomyABSTRACT
The prevalence or azoospermia .in the general population has been estimated to be 2 percent. Azoospermia is found in up to lO to 20 per cent of the men who present to an infertility clinic. The main causes are testicular failure and ductal obstruction. The ejaculatory duct obstruction was reported about 6 percent of the ductal obstruction. We present a case of a young adult azoospermic male patient with bilateral obstruction of the terminal ejaculatory duct who was treated successfully by transurethral incision using Collings cold knife in the area of the ejaculatory ducts.