Department of Andrology, The Second Affiliated Hospital of Kunming Medical University.
Department of Andrology, The Second Affiliated Hospital of Kunming Medical University;
J Vis Exp. 2023 Dec 8(202). doi: 10.3791/66146.
Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.
经尿道射精管切除术（Transurethral resection of ejaculatory duct，TUERD）是治疗由射精管囊肿引起的射精管梗阻（ejaculatory duct obstruction，EDO）的主要手术方法。为了暴露射精管，通常需要切除精阜。然而，保留精阜结构可以更好地模拟正常的生理解剖结构。保留精阜可能会增加术后远端射精管瘢痕形成的风险，导致再次梗阻或精液量减少。因此，我们尝试了一种新的技术，即保留精阜，与 TUERD 相比，该技术相对更容易且更安全。以下是手术步骤：1. 将 6F 精囊镜通过尿道外口插入至精阜附近，找到病变侧射精管的开口，并将导丝插入囊肿内。这一成功的步骤保留了精阜，最大限度地保留了远端射精管的抗反流机制。2. 钬激光扩大病变侧射精管开口至 5mm，减少术后射精管开口关闭的可能性，并简化手术过程。3. 在囊肿内创建一个窗口以进入对侧精囊，然后使用钬激光烧灼和扩张开口至 5mm，将对侧射精管重新引导至囊肿腔内。这种改良保留了健康侧射精管的开口，并为精液提供了新的流出通道，降低了术后精液量减少的风险。患者术后无并发症，住院时间更短，精液量得到改善。因此，这种手术方法简单有效。
