Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification.

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Anatomical study of the seminal vesicle system for transurethral seminal vesiculoscopy.

Because of a general lack of knowledge regarding the precise anatomy of the seminal vesicle system, efforts to use transurethral seminal vesiculoscopy (TSV) are currently constrained. We investigated 26 normal adult male specimens. Contrast medium was injected into the seminal vesicle system in 18 specimens and the openings of the ejaculatory ducts were examined with an operating microscope. India ink was injected into the urethra in four specimens to investigate the function of the ejaculatory duct valve. Another four specimens were examined histologically to identify the anatomical relationships of the seminal vesicle system. We found that the openings of the ejaculatory ducts were covered by the ejaculatory duct valve, which could be classified into two types and acted as a one-way valve. The apex of the seminal colliculus together with the right and left openings of the ejaculatory ducts formed a shape resembling an isosceles triangle. This could be used to locate the openings of the ejaculatory ducts during TSV. The ejaculatory ducts can be classified into two types according to their course. During surgery, efforts must be made to protect the ejaculatory duct valve. During inspection or surgery, the second segment and the angles of the ejaculatory ducts, particularly in Type Ib and Type II cases, require particular attention. Clin. Anat. 32:244-252, 2019. © 2018 Wiley Periodicals, Inc.

[Distribution of ejaculatory duct openings and the method of entering the vesiculoscope into the seminal vesicle].

Objective: To search for an optimal method of entering the seminal vesiculoscope based on the distribution of ejaculatory duct openings. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra.

Loss of ejaculation can follow transurethral resection of the prostate (TURP). Periverumontanal prostate tissue is preserved in ejaculation-preserving TURP (ep-TURP). Knowledge of ejaculatory duct anatomy in relation to the prostatic urethra can help in ep-TURP. This was evaluated in cross-sections of the prostate using a 3 D model to determine a safe zone for resecting the prostate in ep-TURP. A 3 D reconstruction of the ejaculatory ducts was developed on the basis of six prostate gland cross-sections. The measurements obtained from the 3 D model were standardized according to the maximum width of the prostate. Simple linear regressions were used to predict the relationships of the ejaculatory ducts. The maximum widths of the prostates ranged from 22.60 to 52.10 mm. The ejaculatory ducts entered the prostate with a concavity directed posterolaterally. They then proceeded toward the seminal colliculus in a fairly straight course, and from that point they angulated anteromedially. As they opened into the prostatic urethra they diverged. Significant regression models predicted the relationships of the ejaculatory ducts to the prostatic urethra based on the sizes of the prostates. The 3 D anatomy of ejaculatory ducts can be predicted on the basis of prostate width. The ejaculatory ducts can be preserved with 95% accuracy if a block of tissue 7.5 mm from the midline on either side of the seminal colliculus is preserved, up to 10 mm proximal to the level of the seminal colliculus, during TURP. Clin. Anat. 31:456-461, 2018. © 2017 Wiley Periodicals, Inc.

Three-Dimensional Study of the Terminal Portion in Sprague-Dawley Rat Ejaculatory Ducts.

In mammals, a pair of ejaculatory ducts exists in the urethra at the seminal colliculus. The detailed anatomical structures of the distal end of the ejaculatory ducts of Sprague-Dawley rats were investigated by the computer-assisted three-dimensional reconstruction analysis using light-microscopic serial sections. A three-dimensional reconstruction revealed that in adult rats, the ejaculatory sinus pair consists of two parts: the cranial section - a compartment region composed of a fusion of the ampullary gland duct and the seminal vesicle duct, and the caudal section - a grooved region composed of a long slitlike ejaculatory ostium that extends into the urethra on both sides of the seminal colliculus. But the sphincter structure was not observed. The long axis of the compartment region was approximately 58 µm in length, and that of the groove region was approximately 495 µm. Although many epithelial glands ducts were distributed throughout the ejaculatory sinuses, the prostate and coagulation gland ducts did not open in these sinuses. The urethra was composed of transitional epithelium, while the ejaculatory sinuses were composed of single to stratified cuboidal epithelium. The ejaculatory ducts continued to the ejaculatory ostium in male adult Sprague-Dawley rat were composed of the seminal vesicle ducts received the ampullary gland ducts.

Morphostructural analysis of the male reproductive system and DNA barcoding in Balclutha brevis Lindberg 1954 (Homoptera, Cicadellidae).

Balclutha brevis Lindberg 1954 is an allochthonous leafhopper infesting an invasive grass, Pennisetum setaceum, in Sicily and in mainland Europe; therefore, this species could compete with populations of native species, thus contributing to the loss of biodiversity. Considering the ecological implications of B. brevis, investigations on all its biological aspects represent, therefore, a premise for further studies in applied sciences. Based on the lacking ultrastructural data about the reproductive systems of the Auchenorrhyncha, we carried out morphostructural investigations on the male reproductive system of B. brevis. Further, a first report of DNA barcoding analysis (amplification and sequencing of Cytochrome Oxidase I gene) has also been performed to characterize B. brevis compared to other congeneric species. From a morphological point of view, the male reproductive system of B. brevis has an organization comparable to the general anatomical features of most of the Auchenorrhyncha species; however, comparing our data with those concerning the different groups of Cicadomorpha, some considerations are discussed. As for the histological and ultrastructural investigations, our results show a secretory activity of the various examined structures, mainly in the lateral ejaculatory ducts and in the accessory glands. The latter, in particular, show morphostructural differences comparing the distal tract to the proximal one; moreover, the histochemical techniques showed the possible presence of a lipid component in the peculiar cytoplasmic granules found in the gland cells. The significance of these findings in the accessory glands is discussed. Finally, the ultrastructural features found in the seminal vesicles are different from those of the lateral ejaculatory ducts and are indicative of the different roles played by these structures in the organization of the spermatozoa bundles.

Sperm of Galeorhinus galeus (Elasmobranchii, Triakidae) Traverse an Excurrent Duct System Characterized by Pronounced Regionalization: A Scanning Electron and Light Microscopy Study.

The transport and subsequent maturation of spermatozoa in the vertebrate excurrent duct require the creation of a series of biochemically defined luminal milieus along the length of the duct. Such specialization is accomplished, among others, by changes in the epididymal histoarchitecture. Here we show that the intratesticular and extratesticular genital ducts of mating Galeorhinus galeus exhibit pronounced regionalization both in terms of epithelial histology and lumen diameter size. Findings also reveal distinct differences in the manner in which the spermatozoa were found in each segment of the duct. Novel scanning electron microscopy evidence is presented showing that the wide lumen ductuli epididymides, which ultimately convey the spermatozoa to the proximal epididymis, show functional specialization as well. The wall of the former consisted of cuboidal ciliated and nonciliated cells whose spatial arrangement in the duct wall resulted in a luminal surface showing lengthy rows of cilia-free areas, with each row bordered on both sides by a single row of cilia. The proximal epididymis comprised several subregions whose epithelial histology varied widely. The distal epididymis and ampulla of the epididymis possessed many fingerlike projections and transverse septa, respectively. As the main storage site for spermatozoa, the ampulla completed the bundling of spermatozoa into spermatozeugmata. These were circular sperm masses in which the heads of the spermatozoa were aligned side by side and embedded in a seminal matrix, while their tails extended outward. These findings of pronounced regionalization differ greatly from the rather uniform epididymal histology seen in some rays.

[Semen expulsion under the ureterocystoscope].

OBJECTIVE: To determine the exact location of the opening of the ejaculatory duct in men and provide some basic anatomical evidence for seminal vesiculoscopy and the treatment of ejaculatory duct obstruction. METHODS: We performed ureterocystoscopy for 21 male patients aged 26 - 47 years with hematuria (n = 12), hematospermia (n = 2), glandular cystitis (n = 6), and anejaculation after radical resection of rectal carcinoma (n = 1), and meanwhile, with the consent of the patients, massaged the prostate and ejaculatory duct and observed the outlet of the expelled fluid. Under the microscope, we described the fluid samples with sperm as the expulsion from the ejaculatory duct. RESULTS: Ureterocystoscopy showed that the exact anatomical sites of the expulsion of prostatic fluid and semen in the patients were the side and lower side of the prostatic utricle opening above the verumontanum and the ventral side of the verumontanum. Quantities of sperm were found in the expulsion fluid of 13 of the patients, and no expulsion, including semen, was seen from the prostatic utricle opening. CONCLUSION: Anatomically, the ejaculatory duct openings of males are located at the two sides of the verumontanum adjacent to the opening of the prostatic utricle, rather than in the prostatic utricle above the verumontanum.

Ejaculatory dysfunction.

Ejaculatory dysfunction may occur after many different disorders ranging from traumatic spinal cord injury to diabetes mellitus. With an understanding of the many facets and nuances of the ejaculatory apparatus, both anatomic and neurologic, the well-versed clinician can proceed along a safe, efficient, and appropriate treatment algorithm to help affected men and their partners achieve parenthood.

The ejaculatory ducts and their implications in prostate adenocarcinoma.

OBJECTIVE: To describe the histological characteristics of the ejaculatory duct and their importance in prostate adenocarcinoma. STUDY DESIGN: Anatomical dissection of the prostate and seminal vesicles was performed in 20 autopsies of males without clinical evidence of prostatic pathology. Specimens were totally sampled to study the complete route of the ejaculatory ducts within the prostate, focusing specifically on the histological characteristics of the stroma enfolding the ducts. RESULTS: Ejaculatory ducts are covered by a distinct fibrous capsule that includes lymphatics and blood vessels with a specific spatial and architectural arrangement. Although easy to recognize in normal conditions, the positive nuclear immunostaining of epithelial cells with PAX-2 and PAX-8 may be of help to recognize the ejaculatory epithelium in problematic cases. These arteriolymphatic units made of hyalinized arteries and ectatic lymphatic vessels run parallel to the ejaculatory duct along its intraprostatic course and continue outside the prostate gland in the subadventitial tissue of seminal vesicles. CONCLUSION: The ejaculatory ducts have a unique characteristic histology that allows its recognition in transrectal core biopsies. The issue matters in daily practice and may have prognostic implications in prostate adenocarcinoma since the invasion of this structure has been associated with a high percentage of extraprostatic disease.

The morphology and histology of the male reproductive system in Dolycoris baccarum Linnaeus 1758 (Heteroptera: Pentatomidae)--light and scanning electron micoscope studies.

The male reproductive system of Dolycoris baccarum (Linnaeus 1758) is studied morphologically and histologically using both light and scanning electron microscopes (SEM). The reproductive system of the male D. baccarum consists of a pair of testis, a pair of vas deferens, a pair of seminal vesicles, accessory glands (mesadenia, ectadenia), a bulbus ejaculatorius, a pair of ectodermal sacs, and a ductus ejaculatorius. The number of testicular follicles varies from four to six. The testicular follicles have three different development zones (growth zone, maturation zone, differentiation zone). The testes are connected to the seminal vesicles by the vas deferens. Vas deferens and seminal vesicles, which are fine-long and cylindrical. The seminal vesicle is connected with bulbus ejaculatorius which is balloon-shaped and surrounded with accessory glands. The bulbus ejaculatorius is continuous with ductus ejaculatorius which connected to the aedeagus.

[The prostate gland: a crossroad between the urinary and the seminal tracts]. / La prostate: une glande au carrefour uro-génital.

The prostate's location at the crossroad between the urethra and ejaculatory ducts could explain her urinary and genital function. The currently anatomical model has been proposed by McNeal et al. in 1968. The prostate gland is divided in 4 zones surrounding the urethra in its vertical path from the bladder to the striated sphincter. Transition, Central and peripheral zones consist of tubulo-alveolar glandular tissue secreting the spermatic fluid while the anterior fibro-muscular zone consists of smooth muscle which may start voiding. The confluence between the urinary and genital tract in the prostate explains the anatomic proximity and the intimate relationship between male genital and urinary organs. Elderly anatomical changes of the prostate may therefore be involved in sexual and urinary symptoms. The development of prostate medications may be effective both on voiding and erectile dysfunction.

Structure and ultrastructure of spermatozoa of Chrysomya megacephala (Diptera: Calliphoridae).

The spermatozoa of Chrysomya megacephala are similar to those described for other Brachycera. In this species, the spermatozoa are long and thin, measuring about 590microm in length, of which the head region measures approximately 60microm. The head includes a monolayered acrosome with electron-lucid material, and the shape of the nucleus, in cross-sections, varies from circular to oval with completely condensed chromatin. The centriole was observed in the zone of flagellar implantation, below the "peg" region. In the region of overlap, the followings structures are observed: nucleus, centriolar adjunct, mitochondrial derivatives and axoneme. The two mitochondrial derivatives are of different lengths but similar diameter. The axoneme is of a conventional insectan type with a 9+9+2 microtubular arrangement, with accessory tubules flanked by the electron-dense intertubular material. The male internal reproductive tract consists of testis, vas deferens, seminal vesicle, accessory glands and ejaculatory duct.

Gene expression in the efferent ducts, epididymis, and vas deferens during embryonic development of the mouse.

The tissues of the male reproductive tract are characterized by distinct morphologies, from highly coiled to un-coiled. Global gene expression profiles of efferent ducts, epididymis, and vas deferens were generated from embryonic day 14.5 to postnatal day 1 as tissue-specific morphologies emerge. Expression of homeobox genes, potential mediators of tissue-specific morphological development, was assessed. Twenty homeobox genes were identified as either tissue-enriched, developmentally regulated, or both. Additionally, ontology analysis demonstrated cell adhesion to be highly regulated along the length of the reproductive tract. Regulators of cell adhesion with variable expression between the three tissues were identified including Alcam, various cadherins, and multiple integrins. Immunofluorescence localization of the cell adhesion regulators POSTN and CDH2 demonstrated cell adhesion in the epithelium and mesenchyme of the epididymis may change throughout development. These results suggest cell adhesion may be modulated in a tissue-specific manner, playing an important role in establishing each tissue's final morphology.

Advances in microsurgery and assisted reproduction for management of male infertility.

Microsurgical techniques are often used for reconstruction of the male genital tract in order to restore fertility. Advances in technology have led to improved outcomes for patients and men previously felt to be incapable of fathering children are now biologic parents. Use of the operating microscope has led to improved outcomes in vasectomy reversal and has made possible the connection of the vas deferens to a single delicate epididymal tubule. In addition to advances in the area of magnification, novel techniques such as robotic assisted surgery or use of biologic sealants hold promise for further refinement. New surgical techniques and high power magnification has enabled surgeons to find isolated areas of sperm production in testicles of patients that previously were felt to make no sperm at all. In this article we will review the indications, outcomes, and technological advances in the various microsurgical procedures to treat male infertility are.

Morphologic variations of the prostatic utricle.

Anatomical variations of the prostatic utricle (PU) have rarely been reported despite an understanding of them being required for diagnosing and treating PU anomalies. This study was performed on 57 prostates to clarify the variations of this structure. Fifty prostates were dissected under a surgical microscope, five prostates were used for ultrasonography and dissection, and two others were processed for light microscopy and reconstructed into 3D models. The PU was classified into three types based on the location of its pouch. The most common type was one in which the PU projected out from between the two ejaculatory ducts. The site and shape of the utricular orifice were also diverse on the seminal colliculus, which was most commonly located on the distal three-fourths of the prostatic urethra. The results of this study clarified the variations in the anatomy of the PU and may help improve diagnosis and treatment of PU diseases.

Ultrastructure of male reproductive accessory glands and ejaculatory duct in the Queensland fruit fly, Bactrocera tryoni (Diptera: Tephritidae).

Ultrastructure of male reproductive accessory glands and ejaculatory duct in the Queensland fruit fly (Q-fly), Bactrocera tryoni, were investigated and compared with those of other tephritid flies. Male accessory glands were found to comprise one pair of mesodermic glands and three pairs of ectodermic glands. The mesodermic accessory glands consist of muscle-lined, binucleate epithelial cells, which are highly microvillated and extrude electron-dense secretions by means of macroapocrine transport into a central lumen. The ectodermic accessory glands consist of muscle-lined epithelial cells which have wide subcuticular cavities, lined with microvilli. The electron-transparent secretions from these glands are first extruded into the cavities and then forced out through small pores of the cuticle into the gland lumen. Secretions from the two types of accessory glands then flow into the ejaculatory duct, which is highly muscular, with epithelial cells rich in rough endoplasmic reticulum and lined with a thick, deeply invaginated cuticle. While there are some notable differences, reproductive accessory glands of male Q-flies generally resemble those of the olive fruitfly, Bactrocera oleae, and to a lesser extent the Mediterranean fruit fly, Ceratitis capitata.

Morphology of male reproductive system in three species of Trypoxylon (Trypargilum) Richards (Hymenoptera: Crabronidae).

Variations in the adult male reproductive system among different groups of Hymenoptera offer characteristics that help studies on behavior and phylogenetics. The objective of this study was to describe the adult male reproductive system of three Trypoxylon (Trypargilum) species. For that, tissues were disseced, fixed in 2.5% glutaraldehyde in 0.1 M sodium cacodylate buffer, pH 7.2 and postfixed in 1% osmium tetroxide. The material was dehydratated and embedded for light and electron transmission microscopes. The species have similar reproductive systems, which are formed by a pair of testes, each one with three fusiforme follicles, from which emerges an efferent duct that later joins forming a deferent duct. The deferent duct opens into an ejaculatory duct. The first half of the deferent duct is enlarged and differentiated in a region specialized in sperm storage, the seminal vesicle. The accessory gland flows in the post-vesicular region of the deferent duct. The testes and vesicles are both covered with a conjunctive capsule. Sexually mature individuals have all spermatogenesis stages in their follicles. Sperms are released from testes in bundles which are disorganized inside seminal vesicles.

Morphology of male reproductive system in three species of Trypoxylon (Trypargilum) Richards (Hymenoptera: Crabronidae) / Morfologia do sistema reprodutor masculino em três espécies de Trypoxylon (Trypargilum) Richards (Hymenoptera: Crabronidae)

Variations in the adult male reproductive system among different groups of Hymenoptera offer characteristics that help studies on behavior and phylogenetics. The objective of this study was to describe the adult male reproductive system of three Trypoxylon (Trypargilum) species. For that, tissues were disseced, fixed in 2.5 percent glutaraldehyde in 0.1 M sodium cacodylate buffer, pH 7.2 and postfixed in 1 percent osmium tetroxide. The material was dehydratated and embedded for light and electron transmission microscopes. The species have similar reproductive systems, which are formed by a pair of testes, each one with three fusiforme follicles, from which emerges an efferent duct that later joins forming a deferent duct. The deferent duct opens into an ejaculatory duct. The first half of the deferent duct is enlarged and differentiated in a region specialized in sperm storage, the seminal vesicle. The accessory gland flows in the post-vesicular region of the deferent duct. The testes and vesicles are both covered with a conjunctive capsule. Sexually mature individuals have all spermatogenesis stages in their follicles. Sperms are released from testes in bundles which are disorganized inside seminal vesicles.

Variações no sistema reprodutor entre os diferentes grupos de Hymenoptera oferecem caracteres que auxiliam nos estudos de comportamento e filogenia. O objetivo deste trabalho foi descrever o sistema reprodutor masculino de três espécies de Trypoxylon (Trypargilum). Para isso, os tecidos foram dissecados, fixados em glutaraldeído 2,5 por cento em tampão cacodilato de sódio 0,1 M, pH 7,2 e pós-fixados em tetróxido de ósmio a 1 por cento. O material foi desidratado e incluído para microscopias de luz e eletrônica de transmissão. As espécies possuem os sistemas reprodutores muito semelhantes, formados por um par de testículos, cada um com três folículos fusiformes, a partir dos quais emerge um ducto eferente que depois se juntam formando o ducto deferente. O ducto deferente termina no ducto ejaculatório. A primeira metade dos ductos deferentes é dilatada e diferenciada em uma região especializada no armazenamento de espermatozóides, a vesícula seminal. A glândula acessória desemboca na região pós-vesicular do ducto deferente. Testículos e vesículas seminais são envoltos por uma única cápsula conjuntiva. Indivíduos maduros sexualmente apresentam todos os estágios da espermatogênese em seus folículos. Os espermatozóides são liberados dos testículos em feixes, os quais estão desorganizados na vesícula seminal.

Magnetic resonance imaging (MRI) anatomy of the prostate and application of MRI in radiotherapy planning.

Radiotherapy planning for prostate carcinoma has traditionally been performed on computed tomography (CT)-images, on which both the high dose areas (prostate with or without seminal vesicles) as well as the low dose areas (surrounding structures, such as the rectum and bladder) are anatomically delineated. However, magnetic resonance imaging (MRI) provides much more information than CT; it can superbly demonstrate the internal prostatic anatomy, prostatic margins and the extent of prostatic tumours. Hence, MRI becomes a powerful tool to improve the accuracy of planning delineations in radiotherapy for prostate carcinoma and is rapidly gaining popularity in the radiotherapy community. The present paper reviews some important anatomical landmarks and acquisition protocols relevant to radiotherapy planning and explains the rationale and importance of close collaboration between radiotherapists and radiologists in optimizing radiotherapy for patients with prostate carcinoma.