Background: To assess the long-term follow-up outcomes of a novel diagnostic and therapeutic procedure for persistent or recurrent hemospermia by transurethral seminal vesiculoscopy.
Methods: A total of 269 patients with persistent or recurrent hemospermia in our single clinic were successfully performed by transurethral seminal vesiculoscopy through ejaculatory ducts with a slender ureteroscope from September 2008 to December 2015. In our 269 patients, the mean age was 31 years (range, 16–69 years). The course of persistent or recurrent hemospermia was 6 months to 19 years (mean 27 months). All the patients with persistent or recurrent hemospermia were not cured by medical treatment or any other physical therapy. The definite urogenital malignancy of persistent hemospermia were excluded by physical examination including 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 conducted to observe under direct vision through the distal seminal tracts using a 4.5/6.5F rigid ureteroscope.
Results: All the patients with persistent or recurrent hemospermia were confirmed by transurethral seminal vesiculoscopy (162 chronic seminal vesiculitis and 108 seminal calculi secondary to them, 42 Mullerian duct cysts, 16 cysts of seminal vesicle and 3 cysts of ejaculatory duct, 12 benign prostatic hyperplasia). The mean operative time was 21 min (range, 5–90 min). There were no complications including injury of urethra and seminal vesicle and postoperative discomforts in the perineal region. In those 269 cases, 11 patients were out of follow-up. The mean follow-up period was 24 months (range, 3–72 months). Hematospermia in 235 cases disappeared and 23 patients respectively recurred in 5 to 60 months after receiving transurethral seminal vesiculoscopy. Of those 23 cases with postoperatively recurrent hemospermia, 12 cases were cured by re-transurethral seminal vesiculoscopy.
Conclusions: The aetiologies of persistent or recurrent hemospermia are mostly associated with seminal vesiculitis and seminal stone secondary to vesiculitis or ejaculatory ducts obstruction incompletely. Our long-term follow-up results suggest that transurethral seminal vesiculoscopy is effective in the diagnosis and treatment of hemospermia with minimal complication.
