Mello Marcos Figueiredo, Andrade Hiury Silva, Srougi Victor, Arap Marco Antonio, Mitre Anuar Ibrahim, Duarte Ricardo Jordão, Srougi Miguel
Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil.
Int Braz J Urol. 2017 Jul-Aug;43(4):783. doi: 10.1590/S1677-5538.IBJU.2016.0127.
Hemospermia has been considered as a benign and self-limiting condition. It usually has an inflammatory or infectious cause. However, recurrent or persistent hemospermia may indicate a more serious underlying pathology, especially over 40 years of age. Biopsy or surgical excision is indicated in cases of suspicious findings during investigation, such as cysts or masses. Open surgery has been considered the definitive form of treatment, however, it can be associated with significant morbidity. With growing experience in laparoscopics, this approach is becoming the preferable way to access the seminal vesicles. Our objective is to demonstrate a step-by-step operative technique for laparoscopic unilateral vesiculectomy approach in a man with hemospermia.
A 61 year-old man presented with 1 year of hemospermia. He was treated empirically with a fluoroquinolone plus a nonsteroidal anti-inflammatory without resolution of symptoms. Ultrasonography and MRI showed a solid-cystic mass in the right seminal vesicle. The patient was submitted to a laparoscopic unilateral vesiculectomy. Histopathological analysis showed intraluminal dilatation with blood content. During follow-up, complete resolution of symptoms was seen.
Three patients composed our cohort. Mean age was 53 years-old (range 45-61 years), the right side was more commonly affected (two unilateral on the right and bilateral). Mean operative time was 55 minutes (range 40-120min). One patient presented amyloidosis in the histopathological analysis. All cases presented complete resolution of symptoms.
Laparoscopic vesiculectomy is a safe and feasible approach in cases of hemospermia. This technique showed good outcomes and minimal morbidity.
血精症一直被认为是一种良性的自限性疾病。它通常由炎症或感染引起。然而，复发性或持续性血精症可能提示存在更严重的潜在病理状况，尤其是在40岁以上的患者中。在检查过程中发现可疑病变（如囊肿或肿块）时，需进行活检或手术切除。开放手术一直被视为确定性的治疗方式，然而，它可能会带来显著的发病率。随着腹腔镜技术经验的不断积累，这种方法正成为进入精囊的首选方式。我们的目的是展示一种针对血精症男性患者的腹腔镜单侧精囊切除术的分步手术技术。
一名61岁男性出现血精症1年。他接受了氟喹诺酮类药物加非甾体抗炎药的经验性治疗，但症状未缓解。超声和磁共振成像显示右侧精囊有一个实性囊性肿块。该患者接受了腹腔镜单侧精囊切除术。组织病理学分析显示管腔内扩张并有血液成分。随访期间，症状完全缓解。
我们的队列由3名患者组成。平均年龄为53岁（范围45 - 61岁），右侧更常受累（右侧单侧2例，双侧1例）。平均手术时间为55分钟（范围40 - 120分钟）。1例患者在组织病理学分析中出现淀粉样变性。所有病例症状均完全缓解。
腹腔镜精囊切除术在血精症病例中是一种安全可行的方法。该技术显示出良好的效果且发病率极低。
