Transurethral seminal vesiculoscopy in the diagnosis

  

Transurethral seminal vesiculoscopy in the diagnosis

To investigate the efficacy and safety of transurethral seminal vesiculoscopy in the diagnosis and treatment of intractable seminal vesiculitis.To get more news about Seminal vesiculitis treatment, you can visit our official website.

Methods
This prospective observational study enrolled patients with intractable seminal vesiculitis. The transurethral seminal vesiculoscope was inserted into the bilateral ejaculatory ducts and seminal vesicles, via the urethra. The ejaculatory ducts and seminal vesicles were visualized to confirm the diagnosis of seminal vesiculitis and to determine the cause of the disease. The seminal vesicles were washed repeatedly using 0.90% (w/v) sodium chloride before a 0.50% (w/v) levofloxacin solution was injected into the seminal vesicles.
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Results
A total of 114 patients participated in the study and 106 patients underwent bilateral seminal vesiculoscopy. Six patients with postoperative painful ejaculation were treated successfully with oral antibiotics and α-blockers. Two patients with postoperative epididymitis were treated successfully with a 1-week course of antibiotics. Haematospermia was alleviated in 94 of 106 patients (89%), and their pain and discomfort had either disappeared or had been obviously relieved, following treatment.
Seminal vesiculitis is frequently encountered by urologists and andrologists. Haematospermia and lower abdominal (or perineal) pain and discomfort are the most common clinical manifestations. A variety of pathological causes can result in haematospermia.1 Seminal vesiculitis is one of the most common causes, especially in patients under 40 years old.1,2 Although seminal vesiculitis is a benign and self-limiting disease, recurrent episodes lead to anxiety, fear, erectile dysfunction and even male infertility.2 Lesions in the male urogenital tract (urethra, prostate and seminal vesicle) can cause haematospermia, and lower abdominal or perineal pain and discomfort. Systemic diseases, such as serious hypertension and bleeding tendency, can occasionally lead to haematospermia. In addition, the anatomical position of the seminal vesicles is complex and concealed. For these reasons, the diagnosis of seminal vesiculitis relies mainly on the typical clinical manifestations, which means that sometimes it is difficult to distinguish seminal vesiculitis from prostatitis. Transrectal ultrasonography (TRUS) and pelvic magnetic resonance imaging (MRI) are helpful for the diagnosis by excluding congenital abnormalities or tumours in the urogenital tract.3–6 The main treatments for seminal vesiculitis are systemic antibiotics and local physiotherapy. However, long-term medication use and a high recurrence rate are the major problems associated with intractable seminal vesiculitis. Transperineal puncture for direct drug injection into the seminal vesicles may cause damage to the rectum or bladder, bleeding, and infection:7 a more effective and safer treatment method is needed for intractable seminal vesiculitis. The present study summarizes the clinical outcomes following the use of transurethral seminal vesiculoscopy to diagnose and treat patients with intractable seminal vesiculitis.
This prospective observational study enrolled consecutive patients who had recurrent haematospermia with lower abdominal or perineal pain and discomfort between December 2007 and September 2012 in the Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. None of the patients had a history of poorly controlled hypertension, abnormal liver function, coagulation abnormalities, or a history of trauma to or tumours in the urogenital tract. Urinalysis and prostatic fluid examinations prior to enrolment had been normal. Routine semen analysis had demonstrated normal semen volume (2 ml) and red blood cells (RBC; rated from + to + + + + [most serious haematospermia]), based on the quantity of RBCs present in the semen. Preoperative TRUS and MRI examinations had not revealed any congenital abnormalities or tumours in the urogenital tract. Before admission, patients had received standard regimens of systemic antibiotics and local physiotherapy for 3–6 months. However, the symptoms in the patients had been persistent or recurrent and the patients were therefore considered to have intractable seminal vesiculitis on study enrolment.

Patients were placed under general anaesthesia in the dorsal lithotomy position. Transurethral seminal vesiculoscopy was performed using a Wolf F7 rigid ureteroscope (Henke-Sass, Wolf, Tuttlingen, Germany). First, the ureteroscope was inserted into the prostatic urethra for preliminary visualization of the verumontanum (the anatomical landmark near the entrance of the seminal vesicles). The bilateral ejaculatory duct openings were usually identified in the prostatic utricle. In some cases, the openings were located at a position lateral to the verumontanum. Under the guidance of a zebra guidewire (UROVISION, Achenmühle, Germany) in the lumen, the ureteroscope was inserted into the ejaculatory ducts and seminal vesicles with the assistance of hand-controlled intermittent perfusion dilatation, using 0.90% (w/v) sodium chloride (normal saline) (Figure 1A). Then the bilateral ejaculatory ducts and seminal vesicles were observed on the endoscopic monitor. The seminal vesicles contained a honeycomb-like structure, congested walls and a milky, yellow or pink seminal vesicle fluid filled with flocculent turbidity and dark blood clots (Figure 1B). No congenital abnormalities or tumours were observed in the ejaculatory ducts and seminal vesicles. The seminal vesicles were washed repeatedly using normal saline through the endoscopic working channel until the seminal vesicle fluid became clear (Figure 1C). Then a 0.50% (w/v) levofloxacin solution was injected into the seminal vesicles. For those patients who had seminal vesicle stones, laser lithotripsy was performed using a SlimLine™ 200 micron Holmium Laser Fibre (Lumenis®, San Jose, CA, USA) (Figure 1D). Small and crushed stones were washed out or removed using stone forceps or a stone basket. Incomplete obstructions or stenosis of the ejaculatory ducts were incised and dilated by the Holmium Laser Fibre and endoscope. After the operation, a urethral Foley catheter (Bard, Murray Hill, NJ, USA) was retained in place overnight. All patients were required to refrain from ejaculation for ≥2 weeks and were followed up on a monthly basis for 6–12 months.


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