Department of Urology, Clinical Division of Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2012 Apr;125(8):1475-8.
Seminal vesicle stones are one of the main causes of persistent hemospermia. Treatment requires removal of the stone, generally through open vesiculectomy. The purpose of this study was to apply a transurethral seminal vesiculoscopy for diagnosis and treatment of the seminal vesicle stones with an ureteroscope. We assessed whether this transurethral endoscopic technique is feasible and effective in the diagnosis and treatment of the seminal vesicle stones with intractable hemospermia.
Totally 12 patients with intractable hemospermia underwent transurethral seminal vesiculoscopy through the distal seminal tracts using a 7.3-French rigid ureteroscope. Age of patients ranged from 25 to 57 years (mean age (43.7 ± 10.5) years). The patients' symptoms ranged in duration from 4 to 180 months (mean duration (47.8 ± 45.3) months). All patients underwent transrectal ultrasonography, pelvic computed tomography or magnetic resonance imaging before the operation. Positive imaging findings were observed in patients with seminal vesicle stones and dilated seminal vesicle size. A 7.3-French rigid ureteroscope entered the lumen of the verumontanum, and then the seminal vesicle under direct vision. Seminal vesicle stones were found unilaterally in 11 cases and bilaterally in one case.
All 12 patients successfully underwent transurethral seminal vesiculoscopy. The seminal vesicle interior with single or multiple yellowish stones ranging from 1 to 5 mm in diameter was clearly visible. All the stones were easily fragmented and endoscopically removed using a grasper. The operative time was 30 to 120 minutes (mean (49 ± 22) minutes). The mean follow-up period was (6.9 ± 3.0) months (range 3-13 months). Symptoms of hemospermia disappeared after one month in 10 patients and after three months in two patients. Three patients with painful ejaculation could completely be relieved postoperation. There was also improvement in one patient with erectile dysfunction. There were no postoperative complications.
Transurethral seminal vesiculoscopy is safe and effective in the diagnosis and treatment of seminal vesicle stones. This endoscopic technique can be performed with minimal complications.
精囊结石是持续性血精的主要原因之一。治疗需要去除结石，通常通过开放精囊切除术进行。本研究旨在应用输尿管镜经尿道精囊镜检查诊断和治疗精囊结石。我们评估了经尿道内镜技术在诊断和治疗顽固性血精症伴精囊结石中的可行性和有效性。
12 例顽固性血精症患者采用 7.3Fr 硬性输尿管镜经远端精囊管行经尿道精囊镜检查。患者年龄 25-57 岁，平均年龄（43.7±10.5）岁。患者症状持续时间 4-180 个月，平均持续时间（47.8±45.3）个月。所有患者均在术前接受经直肠超声、盆腔 CT 或磁共振成像检查。有精囊结石和精囊扩张的患者影像学检查阳性。7.3Fr 硬性输尿管镜进入舟状窝管腔，然后直视下进入精囊。11 例单侧，1 例双侧发现精囊内单发或多发直径 1-5mm 的黄色结石。所有结石均易碎裂，采用抓钳行内镜下碎石取石。手术时间 30-120 分钟，平均（49±22）分钟。平均随访时间（6.9±3.0）个月（3-13 个月）。10 例患者血精症状在 1 个月后消失，2 例患者在 3 个月后消失。3 例射精痛患者术后完全缓解。1 例勃起功能障碍患者也有所改善。术后无并发症。
经尿道精囊镜检查术治疗精囊结石安全有效，该内镜技术可在最小并发症的情况下进行。
