| Background:The technology of transurethral endoscopy has become one of the major methods for the treatment of the diseases on male distal reproductive tract region such as intractable hematospermia, ejaculatory duct obstruction(EDC) and seminal vesicle cyst(SVC). The precise treatment by the transurethral endoscopy for the distal reproductive tract region diseases depends on the correct understanding of the anatomical features of this region. However, the related anatomical and physiological data previously reported about this region are somewhat controversial. Therefore, the goal of this study is to provide important clinical information for the transurethral endoscopic operation by accurately measuring the physiological data of the distal regions of adult male reproductive tract. And meanwhile, the secondary objective is to evaluate the clinical effects of the transurethral endoscopic operation on the treatment of SVC by retrospectively analyzing the clinical data of the patients treated in our hospital.Methods:(1) Forty six cases of intact postoperative histological specimens come from 35 cases of prostate cancer(Pca) treated by laparoscopic radical prostatectomy(LRP) and 11 cases of bladder cancer(Bca) treated by laparoscopic radical cystectomy(LRC) since October 2012 to February 2015 were observed and studied carefully. The anatomical data of the distal reproductive tract region including the seminal vesicle, vas deferens ampulla and ejaculatory duct were accurately measured. The imaging characteristics and the size of seminal vesicle of these patients under the preoperative pelvic magnetic resonance imaging(MRI) were also observed and detected. A comparative analysis to the data of MRI and the anatomic information was also performed.(2)The morphological characteristics of prostatic utricle and the relationship with the bilateral ejaculatory duct orifice were observed under transurethral endoscopy by using 109 patients with benign prostatic hyperplasia(BPH) who were treated by transurethral resection of prostate in our hospital since June 2014 to August 2014.(3) To further evaluate the clinical application value and effects of transurethral endoscopic treatment of SVC and other distal reproductive tract region diseases, the clinical data of 7 cases of SVCs in our hospital from January 2009 to May 2014, including the clinical history, symptoms, imaging examinations and endoscopic operation techniques, following up information were retrospectively analyzed, and the effects and advantages of transurethral endoscopic treatment of SVC were discussed.Results:(1) The measurement to the 46 cases of Pca or Bca specimens showed that: the lengths of the seminal vesicle are(39.7±7.4)mm on left side and(41.4±8.6)mm on right side; the widths of the seminal vesicle are( 16.5±3.3) mm on left side and(16.4±3.0)mm on right side; the thickness of the seminal vesicle are(7.8±2.4)mm on left side and(7.8±2.3)mm on right side. The lengths of the vas deferens ampulla are(16.7±2.4)mm on left side and(16.2±2.3)mm on right side; the circumference of the vas deferens ampulla are(11.3±2.2)mm on left side and(11.4±2.2)mm on right side. The lengths of ejaculatory duct are( 15.0±2.5) mm on left side and(14.9±2.4)mm on right side; the diameter of ejaculatory duct are(1.2±0.2)mm on left side and(1.1±0.2)mm on right side. The prostatic utricle could be found in 47.8%(22/46) cases with the depth of(6.7±1.7)mm. Prostatic utricle is usually located at the midline of prostate near the verumontanum level and at the plane between the bilateral ejaculatory ducts. Measurement of seminal vesicle on MRI showed that the lengths of seminal vesicles are(39.4±6.6)mm on left side and(41.3±7.6)mm on right side; the widths of seminal vesicle are(17.1±3.4)mm on left side and(16.4±2.9)mm on right side. The statistical analysis indicated that the anatomic data of seminal vesicle sizes between preoperative MRI and postoperative specimens did not have significant difference, which demonstrated that MRI has excellent soft tissue resolution and important value for the diagnosis of the distal reproductive tract region diseases.(2) The endoscopic observation to 109 cases of BPH patients showed that 78.9%(86/109) cases have obvious prostate utricle openings located at the top of the verumontanum, while 21.1%(23/109) cases did not find obvious prostate utricle openings. The ejaculatory duct orifices were located at bilateral sides with about 2mm away from the prostatic utricle openings and they formed a triangular or linear arrangement. Equilateral triangle location accounted for 44.2%(38/86) of cases, inverted triangle location accounted for 25.6%(22/86) and transverse or oblique rectilinear accounted for 30.2%(26/86) of cases.(3)This study on the 7 patients of SVCs treated by transurethral endoscopic operation showed that: the cysts were located behind the bladder, above the prostate, and deviated from the midline which were demonstrated by CT and/or MRI. The lesions ranged in size from 8.3cm×8.0cm×4.9cm to 9.3cm×8.9cm×8.2cm. 2 cases were accompanied with ipsilateral renal and ureteral agenesis and were classified as congenital malformations. The other 5 cases were simple SVCs and were supposed to be secondary to acquired ejaculatory duct obstruction(EDO). All 7 cases were successfully treated by using transurethral endoscopic unroofing of the cysts and extensive electrocautery to the inner mucosa. All the diagnosis of SVCs were confirmed by pathological examination. No malignant disease was found. All pre-operative symptoms were resolved after surgery. No obvious complications were observed during the long term follow-up. No bladder,rectum or other adjacent organ injuries were noted. No patient developed abnormalities of erection, ejaculation or orgasm. The previous SVCs were disappeared or the sizes were significantly decreased 3-6 months later after the treatment.Conclusion:The anatomical structure of male distal reproductive tract region especially the anatomical features of prostatic utricle and ejaculatory duct is delicated and sophisticated, which need pay more attention when performing the transurethral endoscopic operation in this region. MRI has the excellent value and advantages to distinguish the soft tissue in this area and is able to characterize the SVC satisfied. Transurethral unroofing of the cysts and extensive electrocautery to the inner mucosa is safe, effective, easy to perform, and will be the best choice for the treatment of large SVC. |
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