ABSTRACT
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.
Subject(s)
Humans , Male , Ejaculatory Ducts/surgery , Male Urogenital Diseases/surgery , Prostate/surgery , Retrospective Studies , Semen Analysis , Seminal Vesicles/surgery , Vas Deferens/surgeryABSTRACT
Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility.
Subject(s)
Humans , Male , Infertility, Male/surgery , Ejaculatory Ducts/surgery , Infertility, Male/etiology , Microsurgery , Prognosis , Vasovasostomy , Varicocele/complications , Varicocele/surgeryABSTRACT
BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.
Subject(s)
Humans , Male , Female , Pregnancy , Young Adult , Middle Aged , Cysts/complications , Prostatic Diseases/complications , Ejaculatory Ducts/surgery , Hemospermia/etiology , Infertility, Male/etiology , Oligospermia/etiology , Cysts/congenital , Cysts/surgery , Cysts , Prostatic Diseases/congenital , Prostatic Diseases/surgery , Prostatic Diseases , Ejaculatory Ducts , Heart Valve Prosthesis Implantation , Kidney Transplantation , Postoperative Complications , Transurethral Resection of Prostate , Ultrasound, High-Intensity Focused, TransrectalABSTRACT
La Linfadenectomía lumboaórtica, como terapia del Ca de testículo no seminomatoso,ha sido cuestionada durante los últimos años por su iatrogenia (cercana al 100 por ciento) que consiste en la pérdida de la eyaculación. Desde 1988 se ha desarrollado una técnica de Linfadenectomía lumboaórtica radical bilateral con preservación por disección, de estructuras nerviosas responsables de la eyaculación, de acuerdo a un protocolo quirúrgico personal basado en los estudios anatómicos del Dr. Lange P. (2) y propuestas del Dr.Donohue J. (3). Se analiza los fundamentos y se describe la técnica desarrollada. Se presentan los resultados de una serie de 27 pacientes portadores de Ca. testicular no seminomatosos, de bajo estadío clínico, en que se efectuó Linfadenectomía con la técnica propuesta. Se conservó la eyaculación en el 100 por ciento de los pacientes. Se constató 29 por ciento de estadío II (metástasis linfática). No se ha registrado progresión abdominal de la enfermedad en observación de uno a seis años. Esta propuesta demuestra la factibilidad de conservar la eyaculación, sin perder el cárácter radical de la linfadenectomía lumboaórtica (L.L.A.), en el tratamiento de Ca de testículo no seminomatoso