AB080. Study on the endoscopic minimally invasive operation of male distal reproductive tract region

Objective: To evaluate the clinical effects of the transurethral endoscopic minimally invasive operation on the treatment of severe, persistent hematospermia in cases that were refractory to conservative treatments by retrospectively analyzing the clinical data of the patients treated in our hospital.

Methods: Clinical data from 216 patients with persistent and refractory hematospermia in our hospital since January 2009 to May 2015 was retrospectively analysed. Data collected included history, symptoms, as well as ultrasound and MRI of the morphological features of the bilateral seminal vesicles (SV) and ejaculatory duct (ED) areas. Criteria for inclusion were hematospermia symptoms that occurred more than six times, that lasted more than 6 months, and that did not improve after >1 month of conservative treatment. Patients underwent transurethral resection of the ejaculatory duct (TURED) and/or seminal vesiculoscopy and with a post-surgery follow-up. The effects and advantages of transurethral endoscopic treatment of refractory hematospermia were discussed.

Results: The age range of the patients was 21-80 years (mean age =43.2 years). Hematospermia among patients lasted between 6 and 120 months (mean duration 35.2 months). The operation types includes: (I) seminal vesiculoscopy + seminal vesicle irrigation; (II) transurethral resection of the cysts including the seminal vesicle cyst, utricular cyst, Mullerian duct cyst, Wolffian duct cyst and the fulguration of the cyst wall; (III) lithotripsy to the stone of seminal duct; (IV) the fulguration of the abnormal blood vessels at posterior urethra. The operation time ranged from 20-65 min (mean, 33 min). Blood losses ranged from 5 to 20 mL (mean, 12 mL). The seminal vesiculoscopy examination and related procedure were successfully performed in 211 patients, and were failed to perform the procedure in five patients because of the atrophy or abnormal anatomy of the seminal vesicles. Pathological examination were performed in some patients with suspicious lesions and revealed that the SV specimens had non-specific, chronic inflammation in the wall of the SV, but without tuberculosis or neoplasm. 204 patients were followed up for 2-72 months (mean, 35 months). The hematospermia of all the patients were disappeared within 2-6 weeks and 94.6% (193/204) of the patients did not appear the hematospermia anymore. 5.4% (11/204) of the patients present a recurrence after 5-20 months, six of them performed the second time seminal vesiculoscopy and were recovered later, five of them were recovered by the conservative treatment (oral drug administration). No intra- or post-operative obvious complications were observed. 3.9% (8/204) of the patients complained that the orgasms were slightly decreased in orgasmic intensity after operation, but 96.1% (196/204) of the patients did not complain any change of the orgasms.

Conclusions: The transurethral seminal vesiculoscopy examination and related procedure including dilation of ejaculatory ducts, incision of the verumontanum or the distal end of the ejaculatory ducts, and incision or resection of the relevant cysts represent a kind of simple, effective, safe and reliable approaches for the management of refractory cases of hematospermia that do not respond to conservative treatments.

Keywords: Seminal vesicle (SV); ejaculatory duct (ED); anatomy; cyst; minimally invasive operation; seminal vesiculoscopy