Zhang Wei, Xiao Guang'an, Qin Shengfei, Reed-Maldonado Amanda B, Xu Jian, Chen Guanghua, Wang Lei, Zhou Tie
1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
2 Department of Urology, University of California-San Francisco , San Francisco, California.
J Endourol. 2017 Dec;31(12):1277-1282. doi: 10.1089/end.2017.0390. Epub 2017 Dec 6.
Transurethral seminal vesiculoscopy (TSV) provides an efficient approach to diagnose and treat hematospermia, but still needs further improvement in manipulation and corresponding instruments. In this study, we develop an innovative technique with ultrasonic lithotripter (EMS) to treat severe, persistent hematospermia.
Data of patients who underwent TSV with or without ultrasonic lithotripter between May 2012 and December 2015 was reviewed. For the innovative procedure, a 3.3F ultrasonic lithotripter was introduced through the working channel of an 8F seminal vesiculoscope to remove calculi, blood clots, or purulent material, whereas in routine procedure, the holmium laser lithotripsy was performed with lower energy (maximum power 10 W). Complication, hematospermia recurrence, the operative time, and postoperative hospitalization were recorded.
A total of 30 patients, 16 in Group A (routine TSV) and 14 in Group B (TSV with ultrasonic lithotripter procedure), were involved in this study. The median follow-up time for patients in Group A and B was 28 and 31 months, respectively. The mean operative time in Group A and B was 66 and 50 minutes, respectively (p < 0.05). All the TSV procedures in Group B were successful, except one patient had a two-stage procedure because of right seminal vesicle stones accompanying with pus. One patient in Group A had the discontinuation of the procedure because of accidental bleeding during stone fragmentation. During the follow-up, two patients in Group A had recurrent hematospermia and underwent the second TSV, whereas no recurrence happened in Group B. No epididymitis, retrograde ejaculation, rectal injury, incontinence, bladder neck contracture, or erectile dysfunction happened in both groups.
TSV with ultrasonic lithotripter enables a more reliable, effective, and convenient procedure to diagnose and treat severe, persistent hematospermia. It controls the recurrent hematospermia with less operative time and complication.
经尿道精囊镜检查（TSV）为血精症的诊断与治疗提供了一种有效方法，但在操作及相关器械方面仍需进一步改进。在本研究中，我们开发了一种使用超声碎石机（EMS）治疗严重、持续性血精症的创新技术。
回顾了2012年5月至2015年12月期间接受TSV治疗（有或无超声碎石机辅助）的患者数据。对于创新手术，通过8F精囊镜的工作通道插入3.3F超声碎石机以清除结石、血凝块或脓性物质，而在常规手术中，采用较低能量（最大功率10W）的钬激光碎石术。记录并发症、血精症复发情况、手术时间及术后住院时间。
本研究共纳入30例患者，A组（常规TSV）16例，B组（超声碎石机辅助TSV手术）14例。A组和B组患者的中位随访时间分别为28个月和31个月。A组和B组的平均手术时间分别为66分钟和50分钟（p < 0.05）。B组所有TSV手术均成功，除1例因右侧精囊结石伴脓液而进行了两期手术。A组1例患者因结石破碎时意外出血而中止手术。随访期间，A组2例患者血精症复发并接受了第二次TSV手术，而B组未发生复发。两组均未发生附睾炎、逆行射精、直肠损伤、尿失禁、膀胱颈挛缩或勃起功能障碍。
超声碎石机辅助TSV为诊断和治疗严重、持续性血精症提供了一种更可靠、有效且便捷的手术方法。它能以更短的手术时间和更少的并发症控制血精症复发。
