Transurethral seminal vesiculoscopy for intractable hematospermia: experience from 144 patients

Abstract

Purpose: to describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the area of the verumontanum, and to determine the safety of this procedure, especially in terms of postoperative complications.

Methods: This retrospective observational study enrolled 144 patients with intractable hematospermia from May 2011 and August 2019. A 4.5/6.5-Fr vesiculoscope was inserted into the seminal vesicle to deal with the positive findings. The solution of quinolones was used to rinse each seminal vesicle.

Results: In this study, Transurethral seminal vesiculoscopy was successfully performed in 139 patients (96.53%). Hematospermia was alleviated or disappeared in 116 (80.56%) patients by less than half a year after surgery. Common intraoperative manifestations were hemorrhage, stones, utricle polyps and cysts. The surgical approach in our study were categorized into four types, including 24 (16.7%), 73 (50.7%), 42 (29.2%), and 5 (3.5%) cases in Type A (natural opening of the ejaculatory duct), B (trans-duct fenestration), C (trans-utricle fenestration), and D (not founded), respectively. Sexual function change was recorded in 12 patients of 111 patients, all by the method of trans-utricle fenestration, including 8 (7.21%), 3 (2.70%), and 1 (0.90%) patients in shorter intravaginal ejaculatory latency time, worse erection hardness and loss of orgasm, respectively.

Conclusion: Transurethral seminal vesiculoscopy is an effective and safe procedure for the management of hematospermia. The anatomy of the distal seminal tract should be understood more deeply and Wu'method (uncover-curtain method) needs to be promoted to verify its universality and safety. Besides, the complications of the function dysfunction should be discussed in the future in multi-center clinical trials.

Keywords: Hematospermia; Therapy; Transurethral seminal vesiculoscopy.

Fig. 1

Anatomy of the verumontanum, utricle and ejaculatory duct

Fig. 2

Approach through seminal vesicle. Arrow A, approach through the opening of ejaculatory duct. Arrow B, approach through the bilateral inner wall of the entrance of utricle. Arrow C, approach through the lateroposterior aspect of the utricle wall. LED, left ejaculatory duct. RED, right ejaculatory duct. LSV, left seminal vesicle

Fig. 3

Perioperative findings in transurethral seminal vesiculoscopy. a Stones in the utricle; b thulium fiber laser applied to crush stones in the utricle; c crushed stones; d grasping forceps applied for removal of stones in the utricle; e big stones in the seminal vesicle; f thulium fiber laser applied to crush stones in the seminal vesicle; g small stone in the seminal vesicle; h old hemorrhage in the seminal vesicle; i seminal plasma in the seminal vesicle