AB088. The application of vesiculoscopy in the patients of hematospermia and ejaculatory duct obstruction (216 cases report)

Objective: To evaluate the clinical effects of the vesiculoscopy and related endoscopic technique on the treatment of ejaculatory duct obstruction (EDO) and 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 or EDO in our hospital since Jan. 2009 to May. 2015 was retrospectively analyzed. 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. Seminal vesiculoscopy and /or transurethral resection of the ejaculatory duct (TURED) or other related procedure were performed according to individual situation. The effects of endoscopic treatment on the refractory haematospermia and EDO were followed up.

Results: The age range of the patients was 21–80 years (mean, 43.2 years). The history of hematospermia lasted for 6 to 120 months (mean, 35.2 months). The operations include: (I) seminal vesiculoscopy + seminal vesicle irrigation; (II) transurethral resection of the cysts in ED area and fulguration of the cyst wall; (III) lithotripsy and/or removing stones of seminal duct; (IV) fulguration of the abnormal blood vessels at posterior urethra; (V) TURED. The operation time ranged from 20 to 65 min (mean, 33 min). The seminal vesiculoscopy and related procedure were successfully performed in 211 patients, and were failed to perform in 5 patients because of the atrophy or abnormal anatomy of the seminal vesicles. 27.3% (59/216) of the patients had cysts in the ED area and 12.5% (27/216) had stone or calcification in the SV, ED or utricular cyst. 204 patients were followed up for 3–72 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 haematospermia anymore. 5.4% (11/204) of the patients present a recurrence after 5~20 months, 6 of them performed the second time seminal vesiculoscopy and were recovered later, 5 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 who more than 40 years old complained that the orgasmic intensity was slightly decreased after operation, but 96.1% (196/204) of the patients did not complain any change of the orgasms. The volume of semen, and the concentration and activity of sperm in 18 in fertile patients were significantly improved, and 38.9% (7/18) of the patients made their spouse pregnant naturally 6–24 months later after operation.

Conclusions: The ejaculatory duct obstruction, stone in the seminal duct and/ or the cysts in the ED area may be the predominant factors for the appearance of hematospermia The transurethral seminal vesiculoscopy technique and related procedure represent a kind of simple, reliable, safe and effective approaches for the management of refractory hematospermia and EDO.

Keywords: Seminal vesicle; ejaculatory duct; cyst; seminal vesiculoscopy