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Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia

Posted by goon2019 
Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia



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.To get more news about Seminal vesiculitis cause hemospermia, you can visit our official website.

Hematospermia is a common clinical symptom in the fields of urology and andrology, and it mainly occurs in patients <40 years of age.[1] The etiology of hematospermia may be classified into inflammation, infection, tumor, ductal obstruction, cyst formation, iatrogenic causes, and systemic conditions, such as severe hypertension or hematological diseases.[2] Hematospermia can last from a few weeks to several years, although it is generally benign and self-limiting.[3] However, symptoms in a portion of patients with hematospermia cannot be improved after medication and hematospermia persists. This condition is called persistent hematospermia. In addition, consistent symptoms of hematospermia often cause great psychological distress to patients, and all types of conservative treatment can fail, posing a challenge to doctors.
Transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) are routine noninvasive diagnostic modalities for evaluating hematospermia. However, limitations in spatial resolution and soft tissue contrast with these methods may not permit complete evaluation of the seminal vesicle and ejaculatory duct.[4] Furthermore, these limitations might even result in a false negative result if there are small lesions. Transutricular seminal vesiculoscopy (TSV) provides a direct visual examination for the interior of the seminal tract and obtains a therapeutic benefit concurrently. However, detailed procedures for this surgery have not been clearly illustrated, particularly regarding gaining access to the ejaculatory duct and seminal vesicle.[5] Therefore, TSV is a challenging procedure for surgeons just beginning to use this procedure.[6] Even for experienced surgeons, the success rate of TSV ranges from 90.9% to 93%.4–8

TRUS is the most widely used tool for examining hematospermia because of its convenience and nonradiation exposure characteristics. TRUS can provide real-time images with good resolution in the process of TSV. The combination between images of spatial structure from TRUS and direct observation in TSV might enable more accurate diagnosis and treatment for hematospermia.

In this study, we performed TSV guided by real-time TRUS in patients with persistent hematospermia. The present study summarizes our experience of patients with hematospermia by illustrating detailed surgical techniques, clinical outcomes, intraoperative findings, and approaches to enter the seminal tract.

This prospective, observational study enrolled consecutive patients who had persistent hematospermia between January 2010 and January 2018 in the Department of Urology, The Second Hospital of Shandong University, Jinan, China. Persistent hematospermia was defined as consistent hematospermia with a duration exceeding 3 months, regardless of medical treatments (including antibiotics with or without nonsteroidal anti-inflammatory medication). All patients underwent physical examination, urinalysis, and blood tests. All patients received at least one type of imaging examinations, including transrectal ultrasound and MRI, before surgery.

Exclusion criteria included poorly controlled hypertension, cirrhosis or deteriorated liver function, anticoagulant therapy, a history of trauma to the urogenital tract, and acute urinary tract infections. Patients with known hematological malignancy were also excluded.

The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. We received ethics committee approval of the Second Hospital of Shandong University with written informed consent obtained from each participant before enrollment.
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