精囊囊肿的诊断和治疗

目的　提高对精囊囊肿的认识 ,以利于正确诊断和有效治疗。　方法　对 16例精囊囊肿患者的诊断和治疗情况进行回顾性总结。 16例患者临床表现以血精最为多见 ,其次为膀胱刺激症状和会阴部不适或疼痛。行直肠指检、B超、CT及MRI等进行诊断。肿物大小为 3 8cm× 3 0cm×2 6cm～ 9 6cm× 5 2cm× 5 0cm ,16例均经病理证实。均行开放性手术治疗 ,其中行精囊切除术12例 ,精囊部分切除术 4例。　结果　 16例均治愈出院。除外 1例患者术后出现附睾炎治愈外 ,均无其它并发症的发生。随访 10例患者 (6例失访 ) 1个月至 2 2年 ,临床症状均消失 ,复查B超或CT均未见囊肿复发。　结论　对血精和难以解释的膀胱刺激症状或尿道生殖系的主诉要考虑患有本病可能 ;直肠指检、影像学检查为精囊囊肿诊断的主要手段。精囊切除术及精囊部分切除术具有良好的效果。     

腹腔镜技术在精囊囊肿外科治疗中的应用

目的 探讨腹腔镜技术在精囊囊肿外科治疗中的应用。方法 本组3例。年龄分别为32、62、41岁。反复出现血精症状6个月～10年。经B超、MR、CT诊断均为左侧精囊囊肿。3例均行腹腔镜下精囊囊肿切除术。结果 腹腔镜下顺利切除精囊囊肿，平均手术时间94．6min，平均估计失血量70ml，平均住院时间7d，术后随访平均8．6个月，患者症状消失，未见复发。结论 腹腔镜手术创伤小、恢复快、住院时间短，是精囊疾病外科治疗的有效方法。     

孤立肾伴发对侧精囊腺囊肿2例报告

例1,右下腹持续隐痛半月,排尿时加重于1991年10月15日入院.查体:下腹未触及肿块.直肠指诊:前列腺3×4cm,其右上方触及囊性肿物,壁光滑,触痛明显,上界触不到.尿常规无异常.B超:前列腺囊肿.静脉泌尿系造影示:右肾,输尿管未显影,左侧正常.肾图:右肾对位区无功能,左侧正常.CT结果;右肾缺如,膀胱右下方占位.输精管造影显示盆腔内右侧精囊充盈扩大,左侧正常.术前诊断:右侧精囊囊肿,右肾缺如.在硬膜外麻醉下手术,术中见右侧精囊职8×7×3cm,内充满咖啡色液体,约80ml,囊壁脆,与之相连的输精管增粗,与膀胱前列腺粘连,行囊肿切除.并探查膀胱,右侧输尿管口缺如,输尿管间嵴发育差.标本病理结果:精囊囊肿,未见精子.     

膀胱平滑肌瘤的诊疗分析

目的:探讨膀胱平滑肌瘤的病因、临床表现、诊治方法和预后。方法:回顾性分析我院2002年~2014年诊断为膀胱平滑肌瘤的6例患者临床资料:男2例,女4例,平均年龄56岁。排尿刺激症状1例,排尿障碍2例,血尿2例,无症状1例。术前均行CT、B超检查及膀胱镜检查,肿瘤直径为1.2~5.6cm,平均3.2cm。6例均采用手术治疗(1例行膀胱部分切除术,5例行经尿道膀胱肿瘤剜除术),术后基底部取活检。结果:术后患者均无血尿,排尿障碍及排尿刺激症状均明显改善,术后随访3个月~6年,平均4.2年,膀胱镜、B超或CT检查无肿瘤复发或转移。结论:膀胱平滑肌瘤常表现为排尿障碍、排尿刺激症状、血尿或腹痛等症状,也可无明显临床表现。诊断主要依靠B超、CT和膀胱镜检查,初诊时误诊率较高;外科手术是其主要的治疗方法,可采用膀胱部分切除术、经尿道膀胱肿瘤剜除术或经尿道膀胱肿瘤电切术,预后良好。     

苗勒管囊肿并乳头状囊腺癌1例报告附文献复习

目的:探讨苗勒管囊肿及其恶性肿瘤的诊断与治疗。方法:回顾分析1例苗勒管囊肿并乳头状囊腺癌患者的临床与病理资料,结合文献复习讨论其病理、临床表现、影像学特点及治疗。患者男性,44岁。主要临床表现为间歇性血精伴终末血尿及不育15年,经直肠B超、盆腔CT、MRI、膀胱镜及活检病理检查确诊为苗勒管囊肿并恶性变。结果:患者经耻骨上膀胱后入路行肿块切除术。术中囊性肿物颈部呈楔形穿过近膀胱颈的前列腺止于后尿道区,而不影响邻近的前列腺组织,证实其来自苗勒系统。术后病理检查为乳头状囊腺癌Ⅱ级,侵及囊壁全层,双侧精囊及射精管未见癌组织浸润。术后未予辅助治疗,随访6个月患者症状消失,排尿通畅。经直肠超声及CT检查无肿瘤复发。结论:苗勒管囊肿合并恶性肿瘤,经直肠B超、盆腔CT、MRI及膀胱镜检查有助于诊断,确诊需病理组织学检查。外科手术治疗效果良好。     

精囊囊肿伴左肾缺如3例报告并文献复习

目的：探讨先天性精囊囊肿的诊断及治疗方法．提高精囊囊肿的诊断和治疗水平。方法：回顾性分析3例先天性精囊囊肿患者临床资料,年龄分别为43、47、53岁。经影像学检查后分别实行开放和腹腔镜于术治疗。结果：B超、CT及MRI均提示膀胱后方囊肿、左侧肾脏缺如,膀胱镜检末寻得左侧输球管开口。1例行开放性精囊囊肿和左输尿管切除术．另2例行腹腔镜下精囊囊肿和左侧输尿管切除术。随访19～40个月．囊肿无复发。结论：精囊囊肿均伴有左侧肾脏缺如,与传统手术相比．腹腔镜手术因具有明显优点．应作为首选方式。     

精囊镜治疗顽固性精囊炎15例报告

目的:分析总结精囊镜在顽固性精囊炎诊断与治疗中的有效性与安全性。方法:回顾性分析我院2016年2月～2017年12月采用小儿输尿管镜诊治顽固性精囊炎15例患者的临床资料,年龄22～62岁,因反复血精或下腹部、会阴部不适就诊,病程均超过3个月,入院前同时口服喹诺酮类和二或三代头孢菌素1个月以上无效或症状反复复发。术前均完善经直肠前列腺、精囊B超及盆腔CT或MRI。术中使用F6/7.5小儿输尿管镜直视下进入前列腺小囊,检查小囊,斑马导丝或镍钛诺导丝引导下通过射精管开口或射精管内侧管壁开窗进入精囊,检查精囊后予以冲洗、取石、止血,必要时活检。结果:15例患者中14例顺利进入精囊(其中2例只完成一侧手术),1例合并前列腺小囊结石,取出结石后因炎症粘连较重而未能成功进入精囊。12例顺利进入双侧精囊,2例仅进入一侧精囊,其中1例黏膜活动性出血,2例合并精囊结石,剩余各例黏膜炎性充血。所有患者均未出现直肠损伤、逆行射精、附睾炎及尿失禁等并发症。1例患者术后出现横纹肌溶解综合征,经支持对症处理后康复出院。15例手术患者均获得随访,平均随访13(3～24)个月,血精患者症状均消失。下腹会阴疼痛症状患者3例中1例明显缓解,2例部分缓解,加用坦索罗辛及抗生素1个月后其中1例症状明显缓解。结论:经尿道精囊镜技术是治疗顽固性精囊炎的一种有效的治疗方法,但需由内镜技术经验丰富的医师操作,可提高手术成功率,降低并发症的发生率。     

原发性精囊恶性肿瘤的诊断及治疗(附3例报告)

目的 探讨原发性精囊恶性肿瘤的诊断及治疗方法。方法 回顾分析了3例原发性精囊恶性肿瘤的症状、体征、检查结果及手术方案，并对患者进行随访，总结了原发性精囊恶性肿瘤诊断及治疗特点。结果 1例行双侧精囊连同膀胱、前列腺、直肠（全盆腔切除术）根治性切除术，2例行精囊肿瘤、膀胱部分、前列腺部分切除术，2例术后随访5年内无复发和转移，1例术后至今（3个月）未复发。结论 原发性精囊恶性肿瘤初期症状不明显，早期诊断困难，容易误诊，但是临床工作中注意该病的存在，可提高诊断率。手术是本病的基本治疗措施，可根据肿瘤的范围、周围器官受累情况选择手术范围。     

膀胱肉瘤5例报告

我院1978～1995年收治膀脱肉瘤5例，均经病理检查证实，现报告如下。资料与结果本组5例，均为男性，其中膀胱平滑肌肉瘤2例，年龄分别为35岁、56岁，膀胱纹肌肉瘤3例，年龄分别为2岁、4岁、78岁。病程11d～5个月。临床表现：血尿2例，耻骨上肿块1例，排尿困难3例，尿潴留1例，尿频、尿痛3例。直肠指检发现肿块3例。术前B超检查发现膀胱占位性病变5例，膀胱镜检查证实有膀胱占位性病变3例。治疗方法：行膀胱部分切除术3例，行膀胱肿瘤切除术2冽，5例术后均经病理检查确诊。其中单发肿瘤3例，多发肿瘤2例。临床分期：Ⅰ期1例，Ⅱ期2例，Ⅲ期2…     

前列腺囊肿的临床特征及微创治疗选择

目的:探讨前列腺囊肿的临床特征、诊断措施与微创治疗方法的选择。方法:本组9例患者,年龄19～46岁,平均29岁。5例以尿频、尿急及会阴部不适等类似"前列腺炎"症状就诊,3例因排尿不畅、尿线变细及排尿费力等就诊,1例因血精就诊,均经B超、MRI检查,其中5例患者均被外院误诊为"慢性前列腺炎"治疗3至17个月。对3例较小的靠近前列腺尿道的囊肿行经尿道前列腺囊肿去顶术,较大6例向尿道及膀胱颈后方突起的囊肿行腹腔镜下囊肿切除术。结果:9例患者均经B超、MRI联合确诊。经尿道手术时间30～50min,出血约20～70ml;腹腔镜手术时间100～150min,出血约30～50ml,术后皮管引流2d,留置导尿管1～2周。所有患者随访3个月至1年,无尿路刺激症状,无排尿困难,阴茎勃起与射精正常。结论:B超和MRI是诊断前列腺囊肿的重要方法。对于靠近前列腺尿道的有症状的囊肿,经尿道前列腺囊肿去顶术疗效确切;当囊肿靠近尿道及膀胱颈的后方时,腹腔镜切除囊肿具有组织显露清楚、不易损伤盆腔组织、创伤小、出血少等优点,是治疗此类前列腺囊肿的最佳选择。     

Retrovesical mass in men: pitfalls of differential diagnosis

PURPOSE: We review the differential diagnosis and treatment of retrovesical masses in men. MATERIALS AND METHODS: During the last 8 years 21 male patients 3 to 79 years old (mean age 47.1) presented with symptoms or signs of a retrovesical mass. Clinical features and diagnostic findings were reviewed, and related to surgical and histopathological findings. RESULTS: The retrovesical masses included prostatic utricle cyst in 3 cases, prostatic abscess in 1, seminal vesicle hydrops in 6, seminal vesicle cyst in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoid liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obturatoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 patients various symptoms were seen and in 4 the mass was incidentally detected. A mass was palpable on digital rectal examination in 16 cases and visible on sonography in 20. For a cystic mass medial location relative to the bladder neck was suggestive of prostatic abscess or utricle cyst, while lateral location was suggestive of seminal vesicle cyst/hydrops or empyema, ectopic ureter or ureterocele. In 6 patients diagnosis was established only by exploratory laparotomy and histopathological examination. CONCLUSIONS: Digital rectal examination and sonography reliably detect a retrovesical mass. Nevertheless, clinical signs and median or lateral location relative to the bladder neck on ultrasound are diagnostic only for cystic lesions. Computerized tomography and magnetic resonance imaging are useful for staging malignant tumors. However, needle or open biopsy is required in most cases to establish a histopathological diagnosis. Exploratory laparotomy and histopathological examination are the procedures of choice when other findings are equivocal.     

Schwannoma of a seminal vesicle

We present the first reported case of a schwannoma of the seminal vesicle that occurred in a 48-year-old man who presented with right lower quadrant abdominal pain. Computed tomography scan and magnetic resonance imaging revealed a mass in the patient's right seminal vesicle. The patient was also found to have a rising prostate-specific antigen level and underwent a transrectal ultrasound-guided biopsy of the prostate and seminal vesicles, which revealed prostate cancer and schwannoma of the seminal vesicle, respectively. Radical prostatectomy with en bloc removal of the seminal vesicle mass was performed and the patient has been free of disease 24 months postoperatively.     

Sperm motility inhibitor from human seminal plasma: presence of a precursor molecule in seminal vesicle fluid and its molecular processing after ejaculation

Human seminal plasma contains a protein factor that has the capacity to inhibit the movement of demembranated and intact spermatozoa. This factor 'seminal plasma motility inhibitor' (SPMI) has been shown to originate exclusively from the seminal vesicles. The present results demonstrate that the biological activity of SPMI in semen decreases rapidly from 1000 U/d, immediately after ejaculation, to 220 U/ml 2 h later. Immunoblots of seminal plasma proteins probed with an antibody against human SPMI, revealed the rapid processing of a predominant 52 kDa SPMI antigen, present in the seminal vesicle secretions. This precursor was degraded initially into intermediate molecular mass fragments of 25–40 kDa, and subsequently into smaller fragments of 17–21 kDa. When seminal vesicle fluid was mixed with prostatic secretions (3: 1 v/v), proteases present in prostatic secretions were shown to be responsible for processing of the SPMI precursor. Addition of protease inhibitors such as phenylmethylsulphonyl fluoride (PMSF, 5 mM), benzamidine (100 mM) or ethylenediaminetetraacetic acid (EDTA, 5 mM) to the mixture of seminal vesicle and prostate secretions partially prevented the loss of activity of SPMI by 54%, 27% and 9%, respectively. However, the simultaneous addition of PMSF and benzamidine conferred almost total stability to the SPMI precursor activity. These results demonstrate that SPMI exists as a predominant 52 kDa precursor form in the seminal vesicles and is processed rapidly after ejaculation into less active, lower molecular mass forms by one or more serine proteases and/or metallo-proteases of prostatic origin which are present in liquefied semen.     

42例血精症病因的诊断与治疗

目的：探讨血精症病因的诊断与治疗。方法：对42例血精症患者中4l例进行超声引导下经会阴精囊穿刺造影，精囊液常规检查和细菌培养及其他检查；1例作直肠指检、CT与超声检查。针对血精症的病因采用多种方法进行治疗。结果：42例血精症的病因分别为前列腺癌、精囊癌和后尿道炎症各l例，精阜开口处息肉4例，精囊炎35例，其中17例并发前列腺炎。2例肿瘤源性血精症采用根治性前列腺和精囊切除术后治愈，35例炎性血精症采用超声引导下经会阴精囊穿刺滴注抗生素治疗后32例血精消失(91．4％)，4例精阜开口处息肉和l例后尿道炎症经相应治疗后痊愈。结论：血精症主要是下尿路生殖道的炎症，尤其是前列腺和精囊炎引起，超声引导下经会阴精囊穿刺和经导管滴注抗生素是一种诊断和治疗慢性精囊炎有效的方法。     

Ectopic ureteral opening in four males: including a case of inverted Y ureteral duplication

Four males with ectopic ureteral opening are reported herein. Case 1 was a 17 year old who complained of miction pain and macroscopic hematuria. Cystoscopy and radiological examinations showed left ectopic ureteral opening into the seminal vesicle associated with left renal agenesis. The left ureter and seminal vesicle were extirpated. Case 2 was a 21 year old who complained of lower abdominal pain. On physical examination, a child's head sized mass was palpable in the midline of the lower abdomen. Operation was performed under diagnosis of intrapelvic tumor, but the mass was cystic dilatation of left ureter which opened into the seminal vesicle. Case 3 was a 19 year old who complained of right CVA colic pain. On cystoscopy, the right ureteral orifice was absent. During the operation, right ureter was found to open into the posterior urethra. Case 4 was a 57 year old who complained of fever. Plain X-ray on the pelvic cavity showed a 82 X 10 mm calcified shadow. CT revealed a right ectopic ureteral opening into the posterior urethra with a ureteral stone in it. On cystoscopy, the right ureteral orifice was identified and pus discharge was observed to flow out of it. Operative exploration demonstrated that the right ureter was inverted Y duplication; one opened into the posterior urethra and the other into the trigone. Seventy nine males with ectopic ureteral opening and 3 with inverted Y ureteral duplication from the Japanese literature are reviewed briefly.     

Cystic schwannoma of a seminal vesicle

We present a case of a cystic schwannoma of the seminal vesicle that occurred in a 50-year-old man who presented asymptomatic. Computed tomography scan and magnetic resonance imaging revealed a cystic mass within the left seminal vesicle. A laparoscopic surgery was performed to remove the mass on request. Histopathological examination finally confirmed a schwannoma of the seminal vesicle. The patient was free of disease 3 months postoperatively.     

精囊扩张的病因及处理

目的:了解精囊扩张的病因及处理方法。方法:选择46例精囊扩张患者,其中精囊炎36例,用精囊内留置导管持续滴注抗生素治疗1周;精囊囊肿3例,直接用精囊内留管吸净囊液并抗炎治疗;射精管开口处结石1例,经尿道精阜电切,取出米粒大小结石1枚;精阜开口处息肉1例,经尿道息肉电切;后尿道炎症2例,抗炎无效后给予后尿道绿激光汽化;PCa3例,根治性前列腺和精囊切除术。结果:精囊炎随访6个月~2年,32例血精消失,4例在治疗后3个月血精症状复发;精囊囊肿、射精管开口处结石、息肉及后尿道炎症随访6个月未复发;PCa术后6个月未复发。结论:精囊扩张的病因复杂,经相应处理后可取得满意的效果。     

Expression of metallothionein in seminal vesicles--an immunohistochemical study

OBJECTIVE: The seminal vesicles and prostate share the same blood supply and exposure to carcinogens. Despite these similarities, fewer than 60 adenocarcinomas of the seminal vesicles have been described, whereas prostate cancer is the most common cancer in men today. Metallothionein plays a significant role in the detoxification of heavy metals. Thus, this study investigated the expression of metallothionein in seminal vesicle tissue. MATERIAL AND METHODS: Twenty individual tissue specimens each of normal seminal vesicle tissue and benign prostatic tissue underwent immunohistochemical staining with a monoclonal mouse anti-metallothionein antibody. RESULTS: Positive immunostaining for metallothionein was found in 8 of 20 (40%) of the seminal vesicle tissues, but in 14 of 20 (70%) of the prostate specimens. Seminal vesicle tissue stained only with weak intensity. CONCLUSION: Metallothionein expression is lower in seminal vesicles than in the prostate. The low cell turnover in seminal vesicle tissue may explain the lower staining activity of this tissue. These findings suggest that metallothionein expression cannot be regarded as the main reason for the vastly different cancer incidence in seminal vesicles and the prostate.