Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study.
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.
['Wang|Xue-Sheng|XS|', 'Li|Ming|M|', 'Shao|Guang-Feng|GF|', 'Sun|Wen-Dong|WD|', 'Zhang|Xiu-Lin|XL|', 'Xiao|Zhi-Ying|ZY|', 'Ma|Zhen|Z|', 'Yuan|Ming-Zhen|MZ|', 'Guo|Li-Qiang|LQ|']
D000328:Adult D000368:Aged D002137:Calculi D002908:Chronic Disease D003560:Cysts D004724:Endoscopy D005500:Follow-Up Studies D051516:Hemospermia D006801:Humans D007249:Inflammation D008297:Male D008875:Middle Aged D011446:Prospective Studies D012008:Recurrence D012669:Seminal Vesicles D018084:Ultrasonography, Interventional D055815:Young Adult
seminal vesiculoscopy persistent hematospermia transrectal ultrasound