Transurethral seminal vesiculoscopy acts as a therapeutic investigation for intractable hemospermia: Step-by-step illustrations and single-surgeon experience.Int J Urol. 2018 06; 25(6):589-595.IJ
To describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the seminal tract, and to report a single-surgeon experience with this procedure.
A total of 38 consecutive patients with intractable macroscopic hemospermia were enrolled from January 2010 to July 2016. A 6/7.5-Fr semirigid ureteroscope was used to enter the seminal tract by one of these two approaches: through either a trans-ejaculatory duct opening or a trans-utricle fenestration. Patient characteristics and their preoperative and postoperative measurements were analyzed retrospectively.
The success rate of transurethral seminal vesiculoscopy was 92.1%, whereas the approaching method in most patients was the trans-utricle fenestration (88.89%). A total of 34 (94.4%) transurethral seminal vesiculoscopy inspections ended with complete remission, even though nearly half of them (47.2%) only disclosed negative perioperative findings. The median period to complete remission was 4 weeks (interquartile range 4-6 weeks) after the procedure. Four patients had recurrent hemospermia, and the median time to recurrence was 21.5 (range 13-48.5) months.
Transurethral seminal vesiculoscopy is a valuable diagnostic tool for intractable hemospermia, and also plays a therapeutic role by blocking the vicious cycle of stasis, calculi and seminal vesiculitis. More familiarity of the anatomy and enough practice would make the learning curve less steep.