O 16. A novel diagnostic and therapeutic technique for persistent and recurrent hemospermia: Transurethral seminal vesiculoscopy with a ureteroscope

Objective: To investigate a novel technique of transurethral seminal vesiculoscopy with a ureteroscope for evaluation and management of persistent and recurrent hematospermia.

Methods: The clinical data of 12 patients with persistent and recurrent hematospermia who had undergone transurethral seminal vesiculoscopy since September 2008 in our center were analyzed retrospectively, and relevant literature was reviewed. Their age ranged from 26 to 67 years (mean 38 years). Twelve patients with a course of hematospermia for 6 months to 12 years (mean: 15 months) were not cured by other treatment. The definite etiologies of persistent and recurrent haemospermia were excluded by physical examination including blood pressure measurement and digital rectal examination, blood PSA and clotting time, and further imaging investigation such as TRUS, CT or MRI. The ejaculatory duct and seminal vesicle were observed under direct vision through the distal seminal tracts using a 7F rigid ureteroscope.

Results: Transurethral seminal vesiculoscopy was successfully performed in all the 12 cases and the mean operative time was 30 min (range 15-90 min). Twelve patients were confirmed by transurethral seminal vesiculoscopy (five seminal vesiculitis, five seminal stone, one vas deferens obstruction, and one seminal cyst). There were no complications including injury of urethra and seminal vesicle and postoperative discomforts in the perineal region. The mean follow-up period was 12 months (range 3- 36 months). Hematospermia disappeared in 10 cases and was alleviated in one case. One patient experienced recurrence 9 months after receiving transurethral seminal vesiculoscopy.

Conclusions: Transurethral seminal vesiculoscopy can be performed easily using slender rigid ureteroscopy with minimal complications. It can be an effective therapeutic approach for treating persistent and recurrent hematospermia.