[Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of azoospermia secondary to ejaculatory duct obstruction].

OBJECTIVE: To evaluate the effect of real-time transrectal ultrasound-guided seminal vesiculoscopy (TRUS-SVS) in the treatment of azoospermia secondary to ejaculatory duct obstruction. METHODS: This retrospective study included 40 cases of azoospermia secondary to bilateral ejaculatory ducts obstruction treated by TRUS-SVS from June 2016 to June 2018 after failure to enter the vesiculoscope through the ejaculatory duct or prostatic utricle. We analyzed the success rate of surgery, operation time, postoperative complications, treatment results, and application value of TRUS-SVS. RESULTS: Real-time TRUS-SVS was successfully performed in 36 (90.0%) of the cases, 33 through bilateral and the other 3 through unilateral seminal vesicle, with a mean operation time of (32.8 ± 16.6) min. Thirty-seven of the cases were followed up for 6－15 (mean 9.3) months, of which sperm were found in 31 at 1－3 months and in 25 at 3－12 months, and pregnancies achieved in 9 cases within 12 months after surgery. No serious complications as retrograde ejaculation, urinary incontinence and rectal injury were observed postoperatively, except 2 cases of epididymitis and 2 cases of hematuria, which were all cured. CONCLUSIONS: For the patients who failed in seminal vesiculoscopy through the ejaculatory duct or prostatic utricle, real-time TRUS-SVS is a recommended procedure with the advantages of a high success rate, less damage to the prostate and rectum, and benefit to the improvement of semen quality.

[Sacral nerve magnetic stimulation combined with extracorporeal shockwave for the treatment of type-â ¢B chronic prostatitis].

OBJECTIVE: To investigate the clinical therapeutic effects of sacral nerve magnetic stimulation (SNMS) combined with extracorporeal shockwave (ECSW) in the treatment of type-ⅢB chronic prostatitis. METHODS: This study included 65 cases of type-ⅢB chronic prostatitis treated in Renji Hospital between March 2017 and August 2018. The patients were aged 34.56 + 7.47 years and had an average disease course of 12.95 + 10.73 months. We randomly assigned the patients to an experimental (n = 33) and a control group (n = 32) to be treated by SNMS+ECSW and biofeedback combined with electrical stimulation, respectively, qd alt, 40 minutes once, for a total of 24 times. Before and after 4 and 8 weeks of treatment, we obtained the NIH-CPSI scores, maximum urinary flow rate (Qmax), average urinary flow rate (Qavg), Self-Rating Depression Scale (SDS) scores and Self-Rating Anxiety Scale (SAS) scores of the patients, recorded their adverse reactions and compared the clinical therapeutic effects between the two groups of patients. RESULTS: After treatment, the experimental group showed significant improvement in the pain score, urination score, quality of life (QOL) score and NIH-CPSI total scores in comparison with the baseline (P < 0.05), even more significant after 8 than after 4 weeks of treatment (P < 0.05), and in all the indexes as compared with the control group (P < 0.05). Qmax and Qavg were remarkably improved at 8 weeks (P < 0.05) and so were SDS and SAS scores at 4 and 8 weeks (P < 0.05), even more significantly in the experimental than in the control group (P < 0.05). Among the 33 patients in the experimental group, 25 (75.8%) responded (14 ［42.4%］ cured or with excellent effect), with a significantly higher effectiveness rate than the control group (7［46.9%］， P < 0.01). No obvious adverse events were observed in any of the patients during the treatment. CONCLUSIONS: SNMS+ECSW can effectively improve the clinical symptoms and QOL of the patients with type-ⅢB chronic prostatitis, without causing obvious adverse reactions. Its long-term therapeutic effect, however, remains to be further studied.