Therapeutic Effect Of Transurethral Seminal Vesiculoscopy In Treatment Of Hemospermia Syndrome And Ejaculatory Duct Obstruction

Background&ObjectiveHemospermia syndrome(HSS)and Ejaculatory duct obstruction(EDO)are clinically common distal seminal tracts disease.Previously,clinical diagnosis usually depend on laboratory tests,seminal vesiculogram(SV),ransrectal ultrasound(TRUS),and magnetic resonance imaging(MRI)and other auxiliary examinations to determine the cause,but in real clinical work,due to the complex anatomy of the distal seminal tracts,the above-mentioned auxiliary examination can not meet the clinician’s Diagnosis and treatment of distal seminal tracts diseases.Since the 1990 s,people have begun to explore the possibility of using transurethral seminal vesiculoscopy to diagnose and treat diseases of distal seminal tracts.Foreign scholars first began to try to treat the distal path of the spermatic tract through the urethra.Since 2006,the transurethral seminal vesiculoscopy has been developed and promoted in China.It is mainly used for the diagnosis and treatment of Hemospermia syndrome(HSS)and Ejaculatory duct obstruction(EDO).It has become a new technology for the disease of the distal end of the distal seminal tracts.At present,there are only a few clinical centers in China that carry out transurethral seminal vesiculoscopy.This technology is not yet fully mature,and no unified medical treatment norms have been formed.Its clinical application skills and long-term efficacy are still in the stage of continuousexploration.In this study,we analyzed the clinical efficacy of transurethral seminal vesicle mirror in the treatment of patients with hemolytic syndrome and ejaculatory duct obstruction,explored the value of the diagnosis and treatment of this technology,and summarized our experience in developing this technology.Materials&MethodsCollection of complete clinical data of 96 patients with hemorrhagic disease(HSS)and ejaculatory duct obstruction(EDO)treated by transurethral seminal vesicles from June 2016 to December 2018 in our Hospital.The clinical case data were divided into two groups: 42 patients in the first group of HSS,aged 23-67 years,mean 37.0 years old,with a course of 0.5 to 10 years,with an average of 2.2 years.Of the 42 patients,31 showed only hematospermia,no other discomfort,and 11 cases were associated with genitourinary tract infections such as lower abdomen,perineal pain,bulging discomfort,urinary frequency and urgency.A second group of 54 patients with EDO,aged 20 to 39 years,averaged 26.1 years.Sperm was not detected in 42 cases of semen analysis,and 12 cases of semen analysis showed asthenozoospermia or necrospermia.The amount of semen is 0.1 to 2 ml,the average is 1.2 ml,the pH is 5.5 to 7.2,the average is 6.6,and the seminal plasma fructose is 0to 9.85 mmol/L for one shot,with an average of 3.89 mmol/L.All cases used transurcthral seminal vesiculoscopy for inspection and for the further treatment.Preoperative examinations include,semen routine,seminal plasma biochemistry,TRUS,seminal vesicle MRI and so on.The catheter was routinely indwelled after surgery.Follow-up patients with clinical symptom relief,semen routine,seminal plasma biochemical results.Postoperative hemorrhage,epididymitis,retrograde ejaculation,urinary incontinence and rectal injury were observed and recorded.The findings and treatment of transurethral seminal vesicles were recorded in detail.HSS group patients before and after surgery: hematospermia,perineal pain and discomfort,lower urinary tract symptoms relief;EDO group patients were analyzed with SPSS 24.0 statistical data,and the preoperative and postoperativesemen volume,PH,and seminal plasma fructose level of EDO patients were analyzed with t test,and p < 0.05 was considered statistically significant.Results1.Intraoperative situation(1)42 patients with HSS successfully completed the operation,the operation time was 24 to 60 minutes,with an average of 39 minutes.In the operation,9 cases were found the ejaculation tube on the surface of seminal colliculus.4 cases were found the ectopic opening of the seminal vesicle and the ejaculatory duct,and 29 cases were treated with guide wire expansion or hohnium laser incision through the prostate utricle.During the operation,13 cases were found to have seminal vesicle stones,and 4 cases were found to have prostate or ejaculatory duct cysts.stone was removed by hohnium laser lithotripsy and stone basket,seminal vesicle in hemorrhagic fluid was rinsed clean.In 42 patients,the fluid of seminal vesicle was remained to bacilliculture,only one case of cultured was positive for Staphylococcus epidermidis.(2)54 cases of EDO patients successfully completed the operation,the operation time was 15 to 50 minutes,with an average of 31 minutes.In the operation,9 cases underwent simple ejaculatory duct expansion by transurethral seminal vesiculoscopy,and 41 cases of ductotomy were performed by transurethral incision of ED,and 4 cases did not find ejaculation tube.Five cases of seminal vesicle stones were found during operation,11 cases with ejaculation cysts,2 cases with prostatic sac cysts,and 2 cases with seminal vesicle cysts.2 Postoperative results(1)In the HSS group,postoperative hematospermia symptoms were completely disappeared in 38 patients(38/42 90.5%),among which,hematospermia symptoms were not alleviated in 2 patients after the first surgery,and after after the second surgery the symptoms were alleviated.4 patients(9.5%)still showed intermittent hematospermia after surgery;Among the 12 patients with perineal pain and discomfort,8 patients(8/12 66.7%)had their symptoms relieved after surgery.Among the 5 patients with lower urinary tract symptoms,3 patients(3/560%)showed relief of symptoms after surgery.In 42 patients,bacterial culture in seminal vesicle fluid was positive in only 1 case,which was staphylococcusepidermidis.(2)Of the 54 patients in the EDO group,32 patients were found to have sperm in the semen routine within 3 months after surgery,and 11 patients were able to detect live sperm in the semen routine within 3 to 6 months after surgery.Sperm was detected in the semen routine of 1 patient 1 month after the surgery,no sperm was detected from 2 months after the surgery,and sperm appeared in the semen 1month after the reoperation of seminal vesicle microscopy 6 months after the surgery.The preoperative and postoperative 3 months of semen volume,semen pH,and seminal plasma fructose were analyzed by t-test.The semen volume of patients after transurcthral seminal vesiculoscopy increased from 1.20±0.54 to 2.79 ±1.07,the difference was statistically significant(P<0.05);the postoperative semen pH increased from 6.61±0.40 to 7.27±0.17,the difference was statistically significant(P<0.05);The seminal plasma fructose increased from 2.71±3.11 to 12.31±6.26,the difference was statistically significant(P<0.05).Postoperatively,only 1 patient in HSS group presented epididymal inflammation,which was cured after antibiotic treatment.ConclusionTransurethral seminal vesicle technique for the treatment of hemorrhagic disease and ejaculatory duct obstruction with good safety and low incidence of complications can significantly improve the symptoms of patients with hemospermia and improve the quality of semen in patients with ejaculatory duct obstruction.