Zhou Ke-Yi, Yang Wen-Zeng, Cui Zhen-Yu, Wei Ruo-Jing, Zhao Chun-Li, Ma Tao, An Feng
Department of Urology, Baoding First Central Hospital, Baoding, Hebei 071000, China.
Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China.
Zhonghua Nan Ke Xue. 2018 Jun;24(6):525-528.
To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.
This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.
Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.
The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.
探讨F4.8可视微型肾镜在血精症诊断和治疗中的实用性及安全性。
本研究纳入12例难治性血精症伴会阴部或下腹部疼痛不适患者。所有患者经2个月的全身抗炎药物治疗及局部物理治疗均无效。术前通过直肠精囊超声、MRI或CT排除精囊肿瘤及结核。在硬膜外麻醉下，使用F4.8微型肾镜经尿道及射精管口进入精囊腔进行镜检，用生理盐水冲洗血凝块，用钬激光碎石并通过网篮取出精囊结石，用钬激光切除并汽化精囊息肉，术后用稀释碘伏冲洗精囊腔。
10例行双侧精囊镜检查的患者中，3例单侧及2例双侧精囊结石患者采用钬激光碎石、生理盐水冲洗及网篮取出治疗，2例精囊息肉患者采用钬激光切除并汽化治疗，另外3例精囊腔内有血凝块患者经生理盐水冲洗后血凝块完全清除。2例行单侧精囊镜检查的患者均接受了精囊腔冲洗以清除血凝块。手术持续时间为10－55（25±6）分钟。术中及术后均未发生直肠损伤、周围器官损伤及尿道外括约肌损伤等并发症。术后24小时拔除尿道导管，72小时停用抗感染药物，术后2周恢复正常性生活。患者随访6－20（7±2.3）个月，其中10例患者血精症及相关症状于术后3个月消失，另外2例术后4个月复发，但经抗生素治疗后好转。
F4.8可视微型肾镜可应用于精囊腔检查及精囊结石、息肉的治疗，具有微创、安全可靠的优点。
