Ectopic seminal tract opening in enlarged prostatic utricle: A report of 22 cases / 中华男科学杂志

Objective@#To explore the diagnosis, classification and treatment of ectopic seminal tract opening in enlarged prostatic utricle (EPU).@*METHODS@#We retrospectively analyzed the clinical data on 22 cases of ectopic seminal tract opening in EPU confirmed by spermography, EPU open cannula angiography or intraoperative puncture of the vas deferens and treated by transurethral incision of EPU, cold-knife incision or electric incision of EPU, full drainage of the anteriorwal, and open or laparoscopic surgery from October 1985 to October 2017.@*RESULTS@#Five of the patients were diagnosed with ectopic opening of the vas deferens and the other 17 with ectopic opening of the ejaculatory duct in EPU. During the 3－48 months of postoperative follow-up, symptoms disappeared in all the cases, semen quality was improved in those with infertility, and 2 of the infertile patients achieved pregnancy via ICSI.@*CONCLUSIONS@#Ectopic seminal tract opening in EPU is rare clinically. Spermography is a reliable method for the diagnosis of the disease, and its treatment should be aimed at restoring the smooth flow of semen based on proper classification and typing of the disease.

A 30-year retrospective study of rare ectopic seminal tract opening cases / 亚洲男科学杂志(英文版)

Ectopic seminal tract opening is a rare congenital malformation. Until recently, there has been a lack of comprehensive reporting on the condition. The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years. We conducted auxiliary examinations on such patients including routine tests, imaging examinations, and endoscopy. Among these 28 cases, there were ectopic opening of vas deferens into enlarged prostatic utricles (6 cases); ejaculatory ducts into enlarged prostatic utricles, Müllerian ducts cysts, and urethras (18 cases, 2 cases, and 1 case, respectively); and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle (1 case). The size of the enlarged prostatic utricle, the type of ectopic seminal tract opening, and the opening's location effectively assisted in the selection of clinical treatment methods, including transurethral fenestration of the utricle, transurethral cold-knife incision, open operation, laparoscopic operation, and conservative treatment. Satisfactory effect was achieved during follow-up. In conclusion, a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.

MRI diagnosis and clinical analysis for autosomal dominant polycystic kidney disease related male infertility / 中华放射学杂志

Objective To improve the recognition and knowledge of autosomal dominant polycystic kidney disease (ADPKD) related male infertility through investigation for MRI characteristics of this disease. Methods Fourteen patients confirmed with ADPKD related obstructive azoospermia were retrospectively analyzed. All patients referred to clinic with male infertility, and obstructive azoospermia were additionally confirmed by laboratory tests and clinical examination. Subsequent abdominopelvic MR examinations were performed to comfirm obstructive factors and obstructive location. All patients were performed an abdominopelvic MR examination including non-enhanced and enhanced MR. MR imaging characteristics were analyzed and summarized by two experienced radiologists. Results MRI results for all cases were classified into 4 groups:10 cases with bilateral polycystic kidneys and bilateral seminal vesicle cysts, 2 cases with bilateral polycystic kidneys, polycystic liver and bilateral seminal vesicle cysts, 1 case with bilateral polycystic kidneys, polycystic liver and absence of bilateral seminal vesicles, 1 case with bilateral cystic kidneys, bilateral seminal vesicle cysts as well as Müllerian duct cyst. A wide range of coronal T2WI scan was necessary to observe cystic lesions in both liver and bilateral kidneys as well as abnormal changes in pelvis. The obstructive sites in all cases were located in level from ejaculatory duct to seminal vesicle. Bilateral seminal vesicle cysts presented as significantly dilated glandular ducts of seminal vesicles, in which flocculence or nodular sediment can be found. Conclusion Male infertility caused by ADPKD-related deferential duct obstrution is characterized by bilateral polycystic kidney disease and Seminal vesicle ejaculatory duct obstruction in MRI, which can be combined with other abnormalities.

Diagnosis and treatment of ejaculatory duct cyst: A report of 2 cases and review of the literature / 中华男科学杂志

<p><b>Objective</b>To investigate the diagnosis and treatment of ejaculatory duct cyst.</p><p><b>METHODS</b>This study included 2 male patients present at the hospital for hemospermia and abnormal sensation in the perineal region in July and August 2014. Both underwent transrectal ultrasonography, routine semen examination, CT, MRI, cystoscopy, and vesiculography before transurethral fenestration of the cysts and pathological examination of the cyst wall specimens. Analyses were made on the clinical presentations, imaging features, pathological characteristics, differential diagnosis and treatment of ejaculatory duct cyst and relevant literature was reviewed.</p><p><b>RESULTS</b>The cyst wall was mainly composed of smooth muscle, the inner wall lined with pseudostratified ciliated columnar epithelia, and with positive expressions of CD10 and Muc6 proteins on immunohistochemical staining, which indicated renal iatrogenic ejaculatory duct cyst. The patients were followed up for 18 and 20 months, respectively. All symptoms disappeared and no recurrence occurred after surgery. Routine semen examination for the two patients showed the semen volumes to be 3.5 and 3.1 ml, sperm concentrations 35 and 32 ×10⁶/ml, grade a sperm 32.0 and 26.0%, grade b sperm 18.0 and 31.0%, and semen liquidation time 30 and 34 minutes, respectively.</p><p><b>CONCLUSIONS</b>Pelvic cystic masses can be detected by transrectal ultrasonography, CT and MRI, but definite diagnosis relies on vesiculography, pathological examination and immunohistochemical staining. Transurethral fenestration is safe and effective for the treatment of ejaculation duct cyst.</p>

Distribution of ejaculatory duct openings and the method of entering the vesiculoscope into the seminal vesicle / 中华男科学杂志

<p><b>Objective</b>To search for an optimal method of entering the seminal vesiculoscope based on the distribution of ejaculatory duct openings.</p><p><b>METHODS</b>Fifty-six patients with refractory hemospermia underwent seminal vesiculoscopy in our hospital from July 2014 to December 2016. We observed the positions of the ejaculatory duct openings under the seminal vesiculoscope, analyzed their distribution, and explored the optimal methods of entering the seminal vesiculoscope according to the success rate of operation, experience of the operators, video data and operation records.</p><p><b>RESULTS</b>Based on the distribution of the positions, the ejaculatory duct openings of the patients were classified into types Ⅰ (the included angle between the medial area of the prostatic utricle edge tangent and the inferior utricle region ≤45°), Ⅱ (the included angle between the lateral area of the prostatic utricle edge tangent and the inferior utricle region >45°), and Ⅲ (the ejaculatory duct opening abnormal or located in the prostatic utricle), which accounted for 42.9% (24/56), 48.2% (27/56) and 8.9% (5/56), respectively. The success rate of entering the vesiculoscope through the natural passage was 83.3% for type Ⅰ and 29.6% for type Ⅱ openings. A bypass method was used for all the 5 cases of type Ⅲ by making a blunt puncture through the lateral wall of the prostatic utricle. Follow-up was completed in 54 of the patients, of whom 52 (96.3%) showed disappearance or significant improvement of the hemospermia symptoms at 1－3 months postoperatively.</p><p><b>CONCLUSIONS</b>Type Ⅱ ejaculatory duct openings are the most commonly seen clinically, and then come types Ⅰ and Ⅲ. For patients with type Ⅰ ejaculatory duct openings, the best way of entering the seminal vesiculoscope was through the natural passage, while for those with types Ⅱ and Ⅲ, the bypass method is recommended.</p>

Seminal vesiculoscopy: Past, status quo, and prospects / 中华男科学杂志

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.

Real-time transrectal ultrasonography in seminal vesiculoscopy / 中华男科学杂志

Objective@#To compare three different pathways for transurethral seminal vesiculoscopy (SVS) and investigate the reliability and efficiency of transrectal ultrasonography (TRUS)-guided SVS (TRUS-SVS).@*METHODS@#We retrospectively analyzed 90 cases of seminal vesiculoscopy conducted directly through the ejaculatory duct or prostatic utricle or under the guide of TRUS. We compared the success rate and complications among the three approaches.@*RESULTS@#Operations were successfully performed in 87 (96.67%) of the 90 cases, 30 through the ejaculatory duct, 37 via the prostatic utricle, and 20 under the guide of TRUS, the operation time ranging from 25 to 75 minutes. Sperm was detected from the seminal vesicle fluid in (92.06%) of the azoospermia patients (58/63) during the surgery and in 77.78% of them (49/63) in semen analysis at 1 week postoperatively. Fifteen hematospermia and 12 spermatocystitis patients were cured. Postoperative follow-up found 20 cases of water-like semen and 3 cases of orchiepididymitis, but no such complications as retrograde ejaculation, incontinence, or rectourethral fistula.@*CONCLUSIONS@#Transejaculatory duct and transprostatic utricle pathways are two common approaches to SVS, while TRUS-SVS may achieve a higher success rate and avoid injury of both the prostate and the rectum.

Diagnosis and treatment of ejaculatory duct obstruction: Current status and advances / 中华男科学杂志

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.

Ejaculatory duct dilation combined with seminal vesicle clysis for refractory hematospermia: A report of 32 cases / 中华男科学杂志

<p><b>Objective</b>To evaluate the effect of ejaculatory duct dilation combined with seminal vesicle clysis in the treatment of refractory hematospermia.</p><p><b>METHODS</b>Using ureteroscopy, we treated 32 patients with refractory hematospermia by transurethral dilation of the ejaculatory duct combined with clysis of the seminal vesicle with diluent gentamicin.</p><p><b>RESULTS</b>The operation was successfully accomplished in 31 cases, with the mean operation time of 32 (26－47) minutes. The patients were followed up for 6－39 (mean 23.6) months. No complications, such as urinary incontinence and retrograde ejaculation, were found after operation. Hematospermia completely disappeared in 27 cases, was relieved in 1, and recurred in 3 after 3 months postoperatively. Those with erectile dysfunction or mental anxiety symptoms showed significantly decreased scores of IIEF-Erectile Function (IIEF-EF) and Self-Rating Anxiety Scale (SAS).</p><p><b>CONCLUSIONS</b>Ejaculatory duct dilation combined with seminal vesicle clysis under the ureteroscope, with its the advantages of high effectiveness and safety, minimal invasiveness, few complications, and easy operation, deserves general clinical application in the treatment of refractory hematospermia.</p>

Seminal vesiculoscopy in the treatment of refractory hemospermia and ejaculatory duct obstruction / 中华男科学杂志

<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>

Application of diagnosis and treatment for infertility patients with ejaculatory duct obstruction by transrectal ultrasound / 中华超声影像学杂志

nosis and treatment of EDO.

Ejaculatory Duct Obstruction(EDO) / 대한비뇨기과학회지

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.

A case of infertility because of ejaculatory duct obstruction / 대한비뇨기과학회지

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.