Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study / 亚洲男科学杂志(英文版)

This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0-97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0-18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

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)

F4.8 visual miniature nephroscope for the diagnosis and treatment of hematospermia / 中华男科学杂志

<p><b>Objective</b>To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.</p><p><b>METHODS</b>This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.</p><p><b>RESULTS</b>Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.</p><p><b>CONCLUSIONS</b>The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.</p>

Etiological factors for calculus-associated seminal vesiculitis: Analysis of calculus composition in 6 cases / 中华男科学杂志

Objective@#To explore the etiological factors for calculus-associated seminal vesiculitis by analyzing the composition of seminal vesicle calculus samples.@*METHODS@#This retrospective study included 6 cases of recurrent hematospermia diagnosed with seminal vesicle calculus by non-contrast pelvic CT. The patients were aged 28 to 69 years, with persistent or recurrent hematospermia for 3 months to 6 years, and 5 of them with a history of acute urethritis. All the patients underwent seminal vesiculoscopy, which confirmed calculus-associated seminal vesiculitis. The calculus samples were obtained with a spiral dislodge and their composition was determined with a second-generation infrared calculus composition analyzer. The patients were followed up for 2 to 12 weeks postoperatively, during which non-contrast pelvic CT was employed for observation of recurrent calculus in the reproductive tract.@*RESULTS@#Pelvic CT scanning indicated recurrence of seminal vesicle calculus in 3 cases at 12 weeks postoperatively, of which, 2 were accompanied with recurrent hematospermia, both observed at 4 weeks after operation. As for the composition of the calculus, the infrared calculus composition analyzer revealed struvite (magnesium ammonium phosphate hexahydrate) in 5 cases and a mixture of calcium oxalate dihydrate, calcium oxalate monohydrate, and carbonate apatite in the other one.@*CONCLUSIONS@#Seminal vesicle calculi are most commonly composed of struvite, and infection is the main etiological factor for calculus-associated seminal vesiculitis.

Hematospermia: An Unusual Cause of Urology Emergency

Abstract Hematospermia is a distressing disorder in sexually active men resulting in great concern to the patient. We report an unusual case of hematospermia with an atypical presentation, involving a 54-year-old man presented with acute urinary retention after sexual intercourse. Although the causes are widely known, arteriovenous malformation as the cause of this disorder has not much been reported in the literature. Transcatheter embolization of internal pudendal artery is a promising option for hematospermia caused by arterial fistula or bleeding.

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.

Clinical application of all seeing needle system in diagnosis and treatment of patients with hematospermia / 中国内镜杂志

Objective To observe the clinical application of all seeing needle system system in diagnosis and treatment of patients with hematospermia. Methods From May 2015 to September 2016, 22 patients with hemospermia were treated with seminal vesiculoscopy and seminal vesicle lithotripsy by using a all seeing needle system instead of traditional seminal vesicle. Results All the patients were successfully found the seminal vesicle gland and successfully entered the seminal vesicle gland, 16 cases had chronic inflammation of the seminal vesicle, dilute iodine rinse, 6 cases of seminal vesicle, holmium laser lithotripsy, stone basket to remove. The average operation time was (15.7 ± 6.2) min. The catheterization was performed the next day after operation. The average hospital stay was 2 d. After follow-up for 3 to 6 months, 20 patients had disappeared (90.9％). No complication was found Disease and long-term complications. Conclusion The all seeing needle system can replace the traditional seminal vesicle for the operation of seminal vesicle. The puncture system is short, directional and maneuverable. It has advantages of short operation time, simple operation, easy to master and no complications.

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>

Technical refinement of seminal vesiculoscopy and clinical application in seminal vesicle disease / 中华泌尿外科杂志

Objective To refine the technique and improve the efficacy of seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle disease.Methods The refined techniques of seminal vesculoscopy,using a patent catheter into the slit-like ejaculatory duct orifice through the verumontanum and another patent catheter introduced into seminal vesicle lumen,were performed in 58 cases,including intractable hematospermia in 42 cases and azoospermia in 16 cases.Results Seminal vesiculoscopy was successfully entered into the seminal vesicular lumen in 46 patients (79％) within 2-3 min.There was no obvious ejaculatory duct orifice in 12 of 16 azoopermia cases,and transurethral resection of verumontanum was performed,then seminal vesiculoscope was directly entered into seminal vesicle lumen.Symptoms of hematospermia were disappeared in 25 cases (60％),improved in 11 cases (26％),and azoospermia were cured in 6 cases (37％),improved in 5 (31％),unchanged in 5 (31％) during the follow-up period of 6-36 months (average 18 months).There were no major or minor complications in this series,and no urine reflux into ejaculatory duct in 19 cases demonstrated by contrast medium.Conclusion Refined seminal vesiculoscopy was technically safe,efficient,simple,and potentially widely used in the cases of hematospermia and ejaculatory duct obstructions.

Chronic Prostatitis: A Possible Cause of Hematospermia

PURPOSE: While hematospermia is mainly caused by genitourinary inflammatory disorders, very few studies have been published on prostatitis-associated hematospermia (PAH) diagnosed using robust prostatitis evaluation methods. Therefore, we have evaluated the incidence of PAH by using systematic methods for evaluating prostatitis. MATERIALS AND METHODS: We evaluated 37 hematospermia patients from a single hospital over the last five years. We classified the patients into PAH versus hematospermia without any evidence of prostatitis (HWP) by using a NIH-Chronic Prostatitis Symptom Index questionnaire and expressed prostatic secretion studies. RESULTS: The mean age was 55.89+/-14.87 years, and the patients were grouped into two groups: one group had 12 HWP patients and the other 25 PAH patients. PAH patients were further sub-classified: chronic bacterial prostatitis (3 patients), chronic nonbacterial prostatitis (10 patients), prostadynia (7 patients), and asymptomatic prostatitis (5 patients). We found Enterococcus faecalis in the three chronic bacterial prostatitis patients. We could not find any statistically significant difference between the PAH and the HWP groups in terms of the age interval, serum prostate-specific antigen level, and prostate volume. Even though there was no statistically significant difference in the items about urination between the two groups, we found a statistically significant difference in the quality of life (QoL) impact for the patients in this study. CONCLUSIONS: Two-thirds of the hematospermia patients were associated with some evidence of prostatitis. Further, the patients with PAH revealed poor QoL compared with the patients with HWP. Therefore, we must evaluate the presence of prostatitis in hematospermia patients and alleviate the prostatitis-associated symptoms to improve their QoL.

Holmium laser incision under ureteroscopy for refractory hemospermia / 局解手术学杂志

Objective To analyse the effect of holmium laser incision through ureteroscopy and simple ureteroscopy treatment for refrac-tory hemospermia. Methods From December 2003 to April 2013,the data of 67 cases with refractory hemospermia were retrospectively ana-lyzed. All the patients underwent semen analysis,transrectal ultrasonography,seminal vesicle ultrasonography,some patients underwent pelvic CT or MRI. Results Simple ureteroscopy were done for 24 cases,holmium laser incision through ureteroscopy were done for 43 cases. Var-ying degrees of ejaculatory duct stenosis or obstruction were observed. Postoperative follow-up was from 6 months to 8 years,in 24 cases of simple ureteroscopy,2 cases experienced recurrence 6 or 8 months later. The ejaculatory duct narrow were found when they received reopera-tion,with holmium laser incision,hemospermia disappeared. No complications such as retrograde ejaculation,urinary incontinence or rectal injury occurred postoperatively. Conclusion The effect of holmium laser incision through ureteroscopy for refractory hemospermia is better than simple ureteroscopy,which is worthy of clinical application needs further observation and summary.

Application value of ureteroscopytherapy in the treatment of hematospermia / 中华泌尿外科杂志

Objective To treat hematospermia by ureteroscopy and investigate its application value for the treatment of hematospermia.Methods Nineteen patients with persistent hematospermia, TRUS,seminal vesicle MRI or CT were examined to exclude seminal vesicle tumor, tuberculosis, prostatic occupancy and preoperative prostatic fluid and drug sensitivity.Transurethral 4.5 - 6 F ureteroscopy entered through the microscopic seminal vesicle, wash of the old blood, reserved perfusion with Quinolones, and the lithoclasty on the seminal stones by holmium laser, resection of small polypi.Results The ureteroscopy was successful in 18 (95%) cases for bilateral seminal vesicle, wash and drug reserved perfusion, and one case was also successful seminal vesicle microscopy on the affected side; five cases with the seminal stones by olmium laser, three cases with small polypi by resection.The averse duration of the procedure was 35 10 -75) min.There were no compliocations during or after the operation.In 18 cases at 6 - 12 months follow-up the hematospermia and symptoms of hematospermia disappeared fully after 90 d.There was recurrence in one case which improved with anti-inflammaotry treatment.Conclusions Ureteroscopic treatment for persistent hematospermia by 4.5 - 6 F ureteroscopy through the seminal vesicle is effective and safe method and results in a micro-wound.

Hematospermia / 대한남성과학회지

Hematospermia, the presence of blood in the semen is a distressing symptom in sexually active men. However, it is usually a self-limiting condition. Although its exact incidence remains unclear, physicians should evaluate such patients closely and thoroughly because of the possibility of underlying malignancy, particularly prostate cancer. Still, confusion remains about how best to evaluate and treat men with hematospermia. The following paper reviews the literature to explain the cause, diagnostic work-up, and management strategies in patients with hematospermia.

Transutricular Seminal-Vesiculoscopy in the Management of Hematospermia / 대한비뇨기과학회지

PURPOSE: To evaluate the etiology and treatment of options in patients with hematospermia, we performed endoscopy of the seminal vesicles in 37 patients with hematospermia. MATERIALS AND METHODS: The patients were evaluated with either transrectal ultrasound (TRUS) or endorectal MRI. Mean age was 47.1 years (range 28-68 years) with duration of infliction being 37 months (range 3 months to 10 years). When the patients who had the definite abnormalities on the imaging studies and did not improve by medications for more than 3 months, transutricular seminal-vesiculoscopy using 6Fr or 9Fr rigid ureteroscope was performed. Patients were followed for more than 3 months after the endoscopic treatment. RESULTS: Hemorrhage was found in the seminal vesicles and the ejaculatory ducts in 23 (62.2%) and 3 (8.1%), respectively. Calculi were present in the seminal vesicles and the ejaculatory ducts in 6 (16.2%) and 2 (5.4%), respectively. Prostatitis was present in 9 (24.3%) patients. All patients except one reported improvement of hematospermia. Postoperative complications including epididymitis or retrograde ejaculation were not observed. CONCLUSIONS: Our series is the first large-scale experience of the seminal vesicle endoscopy in vivo. Transutricular seminal vesiculoscopy can be performed easily with conventional endoscopic equipment. The endoscopic evaluation and management of the hematospermia is a viable clinical option.

The Value of Transrectal Ultrasonography in Evaluation of Hematospermia / 대한비뇨기과학회지

Hematospermia is not an uncommon condition that has brought many patients to doctor's office. In many cases hematospermia is self-limiting and no clear etiology is discovered. Transrectal ultrasonography (US) was performed in 16 patients with hematospermia to evaluation its efficacy in determination of cause. 1. Hematospermia occurred in 16 patients range from 19 to 63 years of age with average of 34. years. Half of them were in the third and a fifth in the fourth decade. 2. In all of patients, urinalysis and urine culture were normal. Rectal palpation and microscopic examination of prostatic secretion had no value in determination of cause of hematospermia. 3. Among the 12 patients who had abnormal transrectal US findings, 4 patients had lesions in seminal vesicle, 3 in prostate and 3 in both. In 2 patients Millenarian duct cysts were found. 4. Among the abnormal US findings, hematoma of seminal vesicle and calcification of prostate were common followed by enlargement of seminal vesicle. The results provide that transrectal ultrasonography is easy and effective method in evaluation of patients with hematospermia.