经直肠实时超声引导精囊镜在治疗射精管梗阻性无精子症的效果分析

目的:探讨经直肠实时超声引导精囊镜(TRUS-SVS)治疗射精管梗阻性无精症的可行性和有效性.方法:回顾2016年6月至2018年6月我院术前确诊为双侧射精管梗阻性无精子症且经射精管开口和前列腺小囊进入精囊均失败40例患者临床资料,采用TRUS-SVS进入精囊,分析手术进镜成功率、手术时间、并发症和治疗效果,评估TRU...     

经尿道精囊镜技术-一种治疗射精管梗阻性无精子症的新方法

目的 探讨经尿道精囊镜技术治疗射精管梗阻性无精子症的可行性和有效性.方法 分析我科自2007年1月至2009年7月采用经尿道精囊镜技术诊治射精管梗阻性无精子症患者21例的临床资料,术前均明确诊断为射精管梗阻性无精子症,术后定期随访患者精液常规及配偶的妊娠情况.结果 本组病例年龄23～36岁,平均年龄28.8岁,所有病例术中均可见射精管狭窄或梗阻,5例患者并可见射精管或精囊中结石,11例患者术后1～3个月内可查及精液中精子,8例在3～12个月内精液常规可查见精子,7例精浆果糖恢复至阳性,4例患者配偶术后8～12个月妊娠,2例患者术后随访12个月未发现精液中精子.所有病例术后均未见附睾炎、逆行射精、尿失禁或直肠损伤等并发症.结论 经尿道精囊镜技术安全、有效、可行,是一种治疗射精管梗阻性无精子症的新方法.     

经直肠实时超声在精囊镜手术中的应用

目的:总结实施精囊镜手术采用的3种不同进镜途径,探讨经直肠实时超声引导下精囊镜手术的可靠性和有效性。方法:回顾性分析自2013年8月至2015年12月实施的精囊镜手术共90例,进镜途径为直接经射精管口、直接经前列腺小囊及经直肠实时超声引导下经前列腺小囊3种方式,进镜后对精囊疾病进行治疗,分别随访其治疗效果,比较3种进镜方式的成功率及并发症。结果:90例患者手术时间为25~75 min,平均时间42.3 min,手术的总成功率为96.67%(87/90)。直接经射精管口(包括异位开口)途径进入精囊30例,60例在正常解剖位置未找到射精管开口,采用经前列腺小囊途径进入精囊37例,上述途径均失败后,采用经直肠实时超声引导下进入精囊20例,3例患者精囊镜手术失败。92.06%(58/63)无精子症患者术中精囊液查见精子,77.78%(49/63)术后1周精液常规见精子。15例血精及12例精囊炎患者术后随访均治愈。术后随访20例患者出现水样精液,睾丸附睾炎3例,无逆行射精、尿失禁及直肠损伤等并发症。结论:经射精管口途径和经前列腺小囊途径为实施精囊镜手术的常规手术方法;而经直肠实时超声引导下经前列腺小囊途径能显著提高精囊镜检查成功率,避免术中对前列腺和直肠的损伤。     

梗阻性无精子症经直肠B超声像表现及其临床意义

目的:探讨梗阻性无精子症经直肠B超的声像表现及其在梗阻定位诊断中的应用价值。方法:对248例临床诊断为梗阻性无精子症的男性患者行经直肠B超检查,观察前列腺、双侧精囊及射精管的声像表现。结果:本组病例前列腺体积平均13.2 ml。前列腺、双侧精囊及射精管形态正常111例。双侧精囊缺如39例,双侧精囊发育不全33例,单侧精囊发育不全、对侧精囊缺如23例,双侧精囊扩张28例,单侧精囊扩张14例。这42例精囊扩张者中射精管扩张18例、前列腺中线部位囊肿17例。结论:梗阻性无精子症的病变类型多样。经直肠B超可以清楚显示前列腺、精囊及射精管的形态与病变,对于判断梗阻性无精子症的病变类型及部位有一定的参考作用。     

精囊镜技术治疗射精管梗阻性无精子症:附36例报告

目的探讨精囊镜技术治疗射精管梗阻性无精子症的可行性和疗效。方法回顾性分析2009年12月至2015年11月中山大学附属第三医院采用精囊镜射精管扩张技术治疗36例射精管梗阻性无精子症患者临床资料。患者年龄23~39岁,平均28岁。术前常规行精液分析、精浆果糖测定和经直肠超声检查等检查明确诊断为射精管梗阻性无精子症。36例无精症患者,精液量0.1~1.8 ml,p H值6.0~7.2,精液常规和离心均未检出精子。结果单纯精囊镜扩张射精管治疗射精管梗阻23例,精囊镜技术联合射精管口切开治疗13例。手术时间12~60 min,平均25 min。33例获得随访,随访时间2~48个月,平均12个月,25例患者在术后1~3个月复查精液常规或离心可找到精子,其中17例精子密度和活力接近正常,7例获得妊娠。8例患者术后复查精液仍未见精子。结论精囊镜射精管扩张治疗射精管梗阻性无精子症技术可行,对于精囊镜技术经验丰富的术者,该方法是治疗射精管梗阻性无精子症安全有效的手段。     

射精管梗阻性无精子症的诊断与治疗(附46例报告)

目的探讨射精管梗阻性无精子症的诊断及经尿道射精管电切术(TURED)的可行性和疗效。方法回顾分析2003年6月～2005年9月间收治的46例射精管梗阻性无精子症患者的临床资料。采用精液常规分析、精浆果糖测定和经直肠超声检查(TRUS)对其进行诊断,患者均使用TURED治疗,术后随访至少3个月以上。结果46例患者精液量0．4～1．9ml,pH值5．6-7．0,精浆果糖降低,一次射精(0～10．8)μmol。TRUS检查：单纯双侧精囊扩张8例,单侧精囊扩张3例,精囊扩张并射精管扩张18例,精囊扩张合并前列腺囊肿者12例,单纯射精管部分扩张或前列腺囊肿者5例。所有患者均完成手术。术后随访3～28个月,40例(86．96%)精液检查有不同程度的改善,22例(47．82%)精液中出现精子,9例(19．56%)精液检查正常；4例(8．7%)妻子妊娠。结论精液分析、精浆果糖测定和TRUS是射精管梗阻的主要诊断方式。TURED是治疗射精管梗阻性无精子症的首选方法。     

彩色多普勒超声在无精子症诊断中应用价值的评估

目的 评价超声在梗阻性无精子症诊断中的作用.方法 158例梗阻性无精子症患者,经过体格体检查、精液分析及血液激素水平测定后,均进行了阴囊超声及经直肠彩色多普勒超声检查.结果 在158例梗阻性无精子症患者的超声检查中,25例无阳性结果,133例超声检查结果异常,阳性率为84.2%.其病因是多方面的,包括远端梗阻和近端梗阻,共分为4种分类：（1）先天性发育异常,如：精囊缺失或精囊发育不良以及输精管单侧及双侧缺失（55例）;（2）射精管梗阻（EDO）（34例）;（3）附睾病变（25例）;（4）炎症性病变（19例）.结论 阴囊超声及经直肠超声检查是临床诊断梗阻性无精子症的重要手段.     

梗阻性无精子症的定位诊断及病因分析

目的探讨梗阻性无精子症的定位诊断及病因.方法回顾性分析2009年6月至2011年12月期间收治的47例梗阻性无精子症患者的临床资料,包括病史、查体、精浆生化检测、经直肠超声检查,通过手术探查最终确定的梗阻部位.结果47例梗阻性无精子症患者中,先天性双侧输精管缺如4例,精囊发育不良3例,射精管梗阻15例,双侧输精管梗阻5例,双侧附睾尾部梗阻13例,双侧附睾头部梗阻3例,附睾一侧头部对侧体部梗阻2例,附睾一侧体部对侧尾部梗阻2例.结论梗阻性无精子症的致病因素为先天发育不良及后天的炎症、创伤等,通过详细的病史采集、查体、精浆生化检测、经直肠超声检查,术前可对大部分梗阻部位作出判断.     

梗阻性无精子症的外科治疗(附56例报告)

目的:探讨梗阻性无精子症的诊断和外科治疗方法。方法:分析2004年10月至2008年11月间收治的56例梗阻性无精子症患者的临床资料,其中43例为射精管梗阻性无精子症,13例疑为附睾水平梗阻性无精子症。常规精液分析、精浆果糖和中性α葡糖苷酶测定以及经直肠超声检查(TRUS)对其进行诊断,必要时行输精管造影检查。43例为射精管梗阻性无精子症使用经尿道射精管切开术(TURED)治疗,13例疑为附睾水平梗阻性无精子症行阴囊探查术,对其中11例确定为附睾水平梗阻行双侧或单侧附睾输精管端侧吻合术,术后随访其疗效。结果:所有患者均完成手术,术后随访3～51个月。43例射精管梗阻性无精子症TURED术后,36例(83.7%)精液检查有不同程度的改善,11例(25.6%)妻子妊娠。11例附睾水平梗阻性无精子症行输精管附睾吻合术后,6例(54.5%)精液检查检出活精子,3例(27.3%)妻子妊娠。结论:精液分析、精浆果糖和中性α葡糖苷酶测定,TRUS和输精管造影是诊断梗阻性无精子症的主要方式。TURED和输精管附睾吻合术分别是治疗射精管梗阻性无精子症和附睾水平梗阻性无精子症的有效方法。     

精囊镜下铥激光治疗射精管梗阻的临床结局分析

目的:评估射精管梗阻所致的少精子症或无精子症患者行精囊镜下铥激光烧灼术治疗后的临床结局。方法:回顾性分析2018年4月至2020年1月42例南京医科大学第一附属医院泌尿外科男科门诊因射精管梗阻导致的少弱精子症或无精子症患者的临床资料,术前均经相关检查诊断明确,术中利用精囊镜寻找射精管开口,铥激光技术解除射精管梗阻,术后定期随访,监测患者精液常规变化,对手术前后参数采用t检验。结果:42例患者术前完善相关检查,均行经尿道精囊镜探查,并辅以铥激光治疗射精管梗阻,平均手术时间为52.7 min,与患者术前两周精液常规相比,患者术后3个月,6个月及9个月精液体积,精子浓度,精子总活力显著改善(P<0.05),所有患者精液常规中均发现精子,其中40例患者于术后3个月内于精液常规中发现精子,2例患者于术后6～9月于精液常规中发现精子,其中7例患者出现术后并发症,包括附睾炎,会阴部或睾丸疼痛及术后血尿,经相应对症治疗后症状消失,所有病例术后均未出现逆行射精,直肠损伤,尿道狭窄或尿失禁等严重并发症。结论:作为治疗射精管梗阻的强有力武器,精囊镜探查辅以铥激光技术可行,术后并发症较少,患者术后精子质...     

Endoscopic extraction of an ejaculatory duct calculus to treat obstructive azoospermia.

Calculous obstruction of an ejaculatory duct is an uncommon cause of azoospermia or low-volume oligospermia in the infertile man. We report the case of a 32-year-old man with azoospermia, low ejaculate volume, and transrectal ultrosonography (TRUS) findings of bilateral seminal vesicle distention. On cystoscopy for planned transurethral resection of the ejaculatory ducts, a calculus obstructing the right ejaculatory duct at the verumontanum was discovered and removed. Three months later, semen analysis showed improvements in volume, sperm concentration, and sperm motility. An ejaculatory duct calculus should be included in the differential diagnosis of obstructive azoospermia or low-volume oligospermia. Magnetic resonance imaging or TRUS may be advisable to identify ductal calculi.     

Transrectal ultrasound and partial ejaculatory duct obstruction in male infertility.

Partial ejaculatory duct obstruction, due to either a congenital or an acquired cyst or ejaculatory duct stenosis secondary to calcification, chronic inflammation, can produce a wide spectrum of seminal fluid abnormalities. Sperm density may range from azoospermia to normospermia while ejaculate volume can be low to normal. Sperm motility is consistently diminished (less than 30%). We have treated 2 patients with ejaculatory duct stenosis whose diagnosis was accurately made with transrectal ultrasonography (TRUS). We now suggest that TRUS be used when there is a low semen volume (less than 1.0 cc), or low motility (less than 30%), or oligospermia (less than 20 million sperm/mL), and normal findings on physical examination with normal serum gonadotropin values in the absence of any other explanation.     

Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia

Aim： To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection （MAGI） who failed to respond to antibacterial treatment. Methods： We selected 67 consecutive patients with MAGI and persistently elevated bacteriospermia （≥ 10^6 colony forming units [CFU]/mL） after three antibiotic courses. Fourteen infertile patients with initial chronic microbial （≥ 10^6 CFU/mL） MAGI who responded to antibacterial treatment （〈 10^3 CFU/mL） served as a control group. All patients and controls underwent transrectal ultrasonography （TRUS） scans and semen analysis. Patients with low seminal plasma volume （〈 1.5 mL） underwent both preejaculatory and post-ejaculatory TRUS examination. Results： TRUS revealed multiple abnormalities indicative of： （i） bilaterally extended prostato-vesiculitis （group A： 52 cases, 77.6%） （nine of these patients also had micro-emphysematous prostate abscess）; and （ii） prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts （group B： 15 cases, 22.4%）. Mean sperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different from those of controls. Conclusion： Although antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria （clinical history, physical and ejaculate signs）. Thus, TRUS may be helpful in the follow-up of these patients.     

Magnetic resonance imaging compared to ultrasound as the preferred method for diagnosing intractable haematospermia

We aimed to evaluate and compare the clinical diagnostic values of magnetic resonance imaging (MRI) and ultrasound in patients with intractable haematospermia. We performed a retrospective review of 23 patients with intractable haematospermia who were diagnosed with seminal vesicle haematocele and/or calculi by transurethral seminal vesiculoscopy (TSV). Patients’ demographics, disease durations, operative times, and MRI and transrectal ultrasound (TRUS) results were recorded. McNemar's test was used to compare the positive diagnostic rates of MRI and TRUS. All patients had undergone preoperative seminal vesicle MRI and TRUS to identify the aetiology of the haematospermia. The average age and disease duration were 39.3 years and 24.1 months, respectively. The mean operative time was 81.1 min. The positive result rates for MRI and TRUS were 95.7% (22/23) and 39.1% (9/23), respectively. Compared with TRUS, MRI had a significantly higher preoperative positive diagnostic rate (p < 0.01). These results suggest that MRI should be considered as a method for diagnosing intractable haematospermia in patients when TRUS findings are negative or inconclusive.     

Transutricular seminal vesiculoscopy

Disorders of the seminal vesicle have been evaluated mainly via imaging techniques. We developed a technique to examine the interior of seminal vesicles endoscopically. In 37 hemospermic patients, transrectal ultrasound (TRUS) or endorectal MRI were performed preoperatively. When the patients had definite abnormalities on the imaging studies and did not improve after medication over a period exceeding 3 months, transutricular seminal vesiculoscopy was performed using a 6F or a 9F rigid ureteroscope. Patients were then followed for at least 3 months. Endoscopic evaluation was also performed in two patients with stage B(1) and D(2) prostate carcinoma. In hemospermic patients, hemorrhage was found in the seminal vesicles or the ejaculatory ducts in 23 (62.2%) and 3 (8.1%), respectively. Calculi were present in the seminal vesicles or ejaculatory ducts in 6 (16.2%) and 2 (5.4%), respectively. In prostate carcinoma patients, seminal vesiculoscopy was similarly informative. Postoperative complications, including epididymitis or retrograde ejaculation, were not observed. Transutricular seminal vesiculoscopy can be performed easily with conventional endoscopic equipment and provides useful information.     

来曲唑联合复方玄驹胶囊治疗肥胖性少弱精子症的临床疗效观察

目的 观察来曲唑、枸橼酸氯米芬分别联合复方玄驹胶囊及维生素E治疗肥胖性少弱精子症的临床疗效.方法 选取2018年8月至2020年8月在洛阳市妇幼保健院生殖医学研究所就诊的188例肾阳不足型肥胖性少弱精子症患者,随机分为来曲唑联合组(A组)和枸橼酸氯米芬联合组(B组)各94例,疗程为3个月,以精子浓度、精子前向运动百分率...     

经尿道射精管口电切术治疗射精管梗阻性无精子症

目的 探讨经尿道射精管口电切术（TURED）治疗射精管梗阻性无精子症的可行性和疗效。方法 对我院2003年6月—2004年12月收治的20例射精管梗阻性无精子症患者,采用精液常规分析、精浆果糖测定和经直肠前列腺精囊超声检查（TRUS）进行诊断,20例患者的精液量0．4～1．6ml,pH值6．0～7．2,精液中均未检出精子,精浆果糖为0～2．6μmoL／1次射精,其中16例的精浆果糖为0。TRUS显示前列腺中线囊肿11例,偏心性囊肿2例,双侧精囊及射精管扩张5例,一侧精囊及射精管扩张2例。所有者均使用TURED治疗,术后随访其疗效。结果 20例均完成手术,手术时间15～50min,术中出血约10～30m1,术后保留导尿管1～7d。术后随访超过3个月的15例患者中,10例（67％）术后精液质量改善,其中3例（20％）患者的配偶妊娠;随访不足3个月另尚未行精液检查。结论 TURED方法简单、安全、有效,是治疗射精管梗阻的有效手段。     

Novel methods for the diagnosis and treatment of ejaculatory duct obstruction

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVES

? To investigate a new method of vas deferens radiography for ejaculatory duct obstruction (EDO). ? To evaluate the effect of a procedure involving dilation of the ejaculatory duct by F9 seminal vesicoscopy.

PATIENTS AND METHODS

? Twenty‐two patients with EDO were diagnosed using semen analysis, semen fructose measurement, transrectal ultrasonography (TRUS) and vas deferens radiography. ? Of these, 18 patients were successfully treated by dilation of ejaculatory duct using F9 seminal vesicoscopy and four patients, whose treatment was unsuccessful, were treated by transurethral resection of the ejaculatory ducts (TURED). ? All patients were followed up for at least 3 months after treatment.

RESULTS

? Semen analyses in all 22 patients showed oligoasthenozoospermia or azoospermia, low semen volume (0–1.9 mL), low pH level (5.6–7.0) and absent or low semen fructose. TRUS and radiography showed pure dilated seminal vesicles on both sides in three patients, partial dilated seminal vesicles in one patient, dilation of both the ejaculatory duct and seminal vesicles in ten patients, dilated seminal vesicles and a prostatic cyst in four patients, and dilated ejaculatory duct or cystic lesions without dilated seminal vesicles in the remaining four patients. ? At >3‐month follow‐up after dilation or TURED, the semen characteristics of 18 patients were improved and sperm were present in the semen in 13 cases. Normal semen analyses were found in 7 patients and 6 patients had conceived. ? Voiding urethral radiography showed that no patients who had undergone dilation by seminal vesicoscopy had urine reflux into the ejaculatory duct. Only one patient showed urine reflux into the seminal vesicle after TURED. ? All patients felt that their symptoms had improved after treatment.

CONCLUSIONS

? The approach to vas deferens radiography using vas deferens aspiration has proved to be an effective and safe method for EDO diagnosis. ? The procedure involving the dilation of the ejaculatory duct using F9 seminal vesicoscopy is equally effective but has fewer postoperative complications than TURED.