Transurethral seminal vesiculoscopy in treatment of oligoasthenozoospermia secondary incomplete ejaculatory duct obstruction: A report of 8 cases / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the utility of transurethral seminal vesiculoscopy with a slender ureteroscope in the treatment of severe oligoasthenozoospermia secondary incomplete ejaculatory duct obstruction (EDO).@*METHODS@#From March 2018 to September 2018, the clinical data of 8 patients with severe oligoasthenozoospermia secondary incomplete EDO treated by the technique of transurethral seminal vesiculoscopy in the Peking University Third Hospital Reproductive Center were analyzed. Preoperative routine included semen analysis, hormone determination, transrectal ultrasonography, pelvic magne-tic resonance examination and other examinations. All the patients were diagnosed with severe oligoasthenozoospermia secondary to incomplete EDO. All the patients were operated by the same surgeon with multiple cases of experience in transurethral surgery, and 1 year follow-up was conducted to evaluate the surgical effect.@*RESULTS@#The average age of the 8 patients was 29 years, and the average operation time was 32 min. Preoperative transrectal ultrasound indicated 6 cases of ejaculatory duct cyst or Mullerian cyst, 1 case of prostate calcification and bilateral seminal vesicle dilatation. The average maximum transverse diameter of the right seminal vesicle in pelvic MRI was 33.60 mm (24.63-42.28 mm), the average maximum transverse diameter of the left seminal vesicle was 32.85 mm (25.91-44.89 mm), the ave-rage maximum antero-posterior diameter was 27.99 mm (21.36-33.12 mm), the average maximum width of the seminal vesicle duct was 10.53 mm (5.93-19.39 mm). There were 5 cases of ejaculatory duct cyst, 2 cases of seminal vesicle hemorrhage, and 1 case of Mullerian cyst. The semen volume [(2.64±0.80) mL], the sperm concentration [(49.76±8.50)×106/mL], and the motility (grade a+b) [(25.76±6.48)%] in postoperation were significantly higher than those in preoperation [(1.46±0.50) mL, (28.78±5.17)×106/mL, and (2.88±0.93)%, P < 0.05]. Two patients conceived naturally during the follow-up of 6 months after surgery. There were no severe complications, such as retrograde ejaculation, urinary incontinence or rectal injury.@*CONCLUSION@#The technique of transurethral seminal vesiculoscopy is safe and effective for treating severe oligoasthenozoospermia secondary to incomplete EDO. However, due to the small sample size of this study, short follow-up time, and the uncertainty in seminal vesicle surgery, it still needs to be further confirmed by long-term follow-up studies with large samples.

Transrectal ultrasonographic features of midline prostatic cysts in infertile men and their semen analysis / 中华医学超声杂志（电子版）

Objective To investigate the transrectal ultrasonographic (TRUS) features of midline prostatic cysts and the semen analysis in infertile men. Methods The ultrasonographic characteristics of midline prostatic cysts were retrospectively analyzed in 34 infertile men, who underwent transrectal ultrasound and semen analysis in Suzhou Hospitial Affiliated to Nanjing Medical University from November 2013 to October 2014. Results Thirty-four patients were detected by transrectal ultrasound with anechoic areas in their prostates. Among them, the cysts could be divided into 3 groups:17 ejaculatory duct cyst, 11 mullerian duct cyst and 6 true prostatic cyst. Ejaculatory duct cysts was connected with ipsilateral seminal vesicle and pointed to seminal hillock showing a water-drop shape on longitudinal view of ultrasound. Mullerian dust cysts were located at the base of the prostates behind the urethra with a water-drop shape on longitudinal view. True prostatic cysts were inside the prostates or under the prostate capsules with a round or oval shape either on longitudinal view or transverse view of ultrasound. Therefore, these midline prostate cysts could be differentiated by their anatomical position and shape. These patients then underwent semen analysis. By semen analysis, there were 13, 4, 1 aspermia and 2, 6, 2 oligospermia in patients with ejaculatory dust cysts, mullerian duct cysts, and true prostatic cysts, respectively. Conclusions Transrectal ultrasound can provide accurate information about the anatomical position and shape of midline prostatic cysts in infertile men. Combined with semen analysis, transrectal ultrasound can provide a reliable evidence for clinical treatment.

Hybrid Method of Transurethral Resection of Ejaculatory Ducts Using Holmium:Yttriumaluminium Garnet Laser on Complete Ejaculatory Duct Obstruction

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.

MRI diagnosis of ejaculatory duct obstruction / 中华放射学杂志

Objective To explore the MRI features of ejaculatory duct obstruction.Methods During January 2003 to Dccember 2010,transrectal ultrasonography (TRUS) was performed for 106 patients and underwent surgical treatment for ejaculatory duct obstruction.Among them,16 patients underwent MRI examination.The MRI features of ejaculatory duct obstruction in these patients were summarized.Results Ejaculatory duct cysts,ranging in size from 4 mm ×4 mm ×7 mm to 4 mm ×4 mm ×9 mm and locating in the paramedian line,were detected in 5 of the 16 patients; ejaculatory duct dilation located in the paramedian line was detected in 7 patients,with the internal diameter of 5 to 30 mm. After contrast injection,significant enhancement of the wall of the ejaculatory duct was observed in 2 patients.Mullerian duct cysts complicated with dilated ejaculatory duct and seminal vesicles were detected in 4 patients,in whom the cysts were located in the median line,ranging in size from 4 mm × 5 mm × 6 mm to 34 mm×35 mm ×44 mm,with inverted teardrop shaped pointing toward the seminal colliculus.ConclusionThe most common MRI features of ejaculatory duct obstruction are ejaculatory duct dilation and ejaculatory duct cysts.

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.