CU 52. Transutricular seminal vesiculoscopy in recurrent hematospermia

Objective: The diagnosis and treatment of recurrent hematospermia presents significant difficulty. Although many urologists have depended solely on transurethral ultrasonography and MRI with an endorectal coil to evalute hematospermia, numerous false-positive results were related to the recognized limits of the various imaging techniques. Therefore, the limits of these techniques have led to attempts to examine the structures using direct observation. Several methods of endoscopic management of hematospermia have been reported. We describe our current techique of transutricular seminal vesiculoscopy and evaluate its efficacy in diagnosing and treating recurrent hematospermia.

Methods: From February 2010 to July 2011, 89 patients with recurrent hematospermia were enrolled this study. All patients performed transurethral ultrasonography or endorectal MRI preoperatively. When the patients experienced hematospermia for at least three months, and failed conservative therapy consisting of oral antibiotics for 4-6 weeks, transutricular seminal vesiculoscopy was performed using a 4.5F rigid ureteroscope. Patients were followed for more than 3 months after the procedures.

Results: The mean age and duration of diseases were 39.1 years (range 20-61) and 8.3 months (range 3-125), respectively. Hemorrhage was found in the seminal vesicles, the utricular lumen and the ejaculatory ducts in 67 (75.3%), 10 (11.2%) and 5 (5.6%), respectively. Calculi were present in the seminal vesicles, the utricular lumen and the ejaculatory ducts 10 (11.2%), 8 (9.0%) and 5 (5.6%), respectively. A midiline cyst was found at 6 cases (6.7%). Biopsy of 5 cases revealed inflammatory, with no evident malignancy. Symptoms of hematospermia disappeared in 72 cases (80.9%) during the follow-up period. Postoperative complications such as epididymitis, retrograde djaculation, or rectal injury were not observed.

Conclusions: Our experience has demonstrated that transutricular seminal vesiculoscopy is safe and effective in the diagnosis and treatment of recurrent hematospermia with minimal complications.