Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia

Objective: To compare the diagnostic yield of transrectal ultrasonography and transurethral seminal vesiculoscopy in patients with persistent hematospermia, and to determine the advantages and disadvantages of both modalities. Methods: We prospectively enrolled 106 patients with persistent hematospermia of mean duration 20.5 months. All patients were evaluated by both transrectal ultrasonography and transurethral seminal vesiculoscopy after excluding definite etiological lesions beyond the reproductive duct system. The diagnostic yield and other technical parameters of both modalities were compared. Results: Final diagnoses were made in 93 patients (87.7%), with transrectal ultrasonography and transurethral seminal vesiculoscopy showing overall diagnostic yields of 45.3% and 74.5%, respectively (P < 0.001). The diagnostic yield of combining transrectal ultrasonography and transurethral seminal vesiculoscopy was significantly higher than that of each modality alone (both P < 0.001). Of the 114 findings of diagnostic value, the most frequent was calculus (47.4%, n = 54), followed by obstruction/stricture (37.7%, n = 43), cyst (8.8%, n = 10), dysplasia (3.5%, n = 4), polyp (1.8%, n = 2) and benign mass (0.9%, n = 1). Transurethral seminal vesiculoscopy showed significant superiority in detecting calculi and obstruction/stricture. Hematospermia disappeared in 95.3% (101/106) of all patients and in 97.6% (83/85) of patients receiving transurethral seminal vesiculoscopy therapy during follow up. No major adverse effects occurred during and after examination. Conclusions: The diagnostic yield of transurethral seminal vesiculoscopy for persistent hematospermia was significantly superior to that of transrectal ultrasonography, especially in lesions diagnosed with calculi and obstruction/stricture. Combining both modalities might provide extra benefits for patients with persistent hematospermia.     

Laparoscopic management of congenital seminal vesicle cysts associated with ipsilateral renal agenesis

PURPOSE: Congenital cysts of the seminal vesicles associated with ipsilateral renal abnormalities are rare. When they are symptomatic, open surgical excision has been the treatment of choice. We present our experience with laparoscopic management and provide a detailed literature review of this entity. MATERIALS AND METHODS: Since 1985, 3 patients with symptomatic seminal vesicle cysts and ipsilateral renal agenesis have been treated at our center. Open surgical excision was performed in 1 patient and laparoscopic management was performed in the other 2. RESULTS: Mean patient age was 35.7 years (range 30 to 42). Presenting symptoms were perineal pain in all 3 cases, dysuria in 2, irritable voiding in 2 and testicular pain in 1. Mean laparoscopic operative time was 195 minutes and mean estimated blood loss was 325 cc. Transabdominal or transrectal ultrasound was performed in 2 cases and computerized tomography was performed in all 3. CONCLUSIONS: Seminal vesicle cysts associated with ipsilateral renal agenesis are rare but they should be considered in men with otherwise inexplicable irritable voiding symptoms, perineal discomfort or other genitourinary complaint of unclear etiology. Evaluation should include digital rectal examination, transrectal and transabdominal ultrasound, computerized tomography and cystoscopy. Laparoscopy provides excellent intraoperative access and visualization with minimal postoperative morbidity. It is likely to become the treatment of choice for this rare developmental anomaly.     

射精管部分梗阻致大鼠血精模型的建立

目的:建立射精管部分梗阻致大鼠血精模型,探讨血精症发病机制。方法:成年雄性SD大鼠50只,分为A组(30只)和B组(20只)。将A组大鼠行右侧射精管部分结扎,B组仅行开关腹(假手术)。于手术后1周行电刺激诱导射精,从A组中选出产生肉眼血精者设为A1组(实验组),从B组中选出射精功能完好者设为B1组(对照组),比较两组间精液常规及精囊内压力。结果:A1组精液量[(0.46±0.12ml]较B1组[(0.91±0.12)ml]减少,差异有显著性(P<0.01);两组精液中白细胞数[(0.83±0.75)/HPvs(0.89±0.78)/HP]及精子密度[(29.85±1.68)×106/mlvs(30.58±1.64)×106/ml]均无统计学差异(P>0.05)。A1组精子活动力[(36.35±3.52)%]较B1组[(61.02±5.35)%]明显减小,有显著性差异(P<0.01)。A1组精囊内压较B1组[(6.73±1.50)cmH2Ovs(1.39±0.56)cmH2O]明显增大,有显著性差异(P<0.01)。结论:射精管部分梗阻可引发血精,且伴随有精液指标的变化,其发生与精囊内压力增高密切相关。     

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.     

评价经直肠彩色多普勒超声在男性不育症精囊和射精管病变诊断中的价值

目的探讨经直肠超声在男性不育症患者精囊和射精管病变诊断中的价值.方法应用经直肠彩色多普勒超声技术对50例男性不育症患者进行精囊和射精管检查.结果男性不育症患者经直肠超声表现呈现多样性特点,其中包括精囊先天性缺如和发育不良、慢性精囊炎如精囊肿大或精囊壁增厚伴钙化,射精管梗阻性病变如射精管扩张以及射精管囊肿,射精管壁钙化等.部分病例未发现明显精囊和射精管病变.结论经直肠彩色多普勒超声可用于射精管梗阻性病变和精囊先天性改变的诊断.对于精囊炎症性表现具有一定诊断意义,它是男性不育症患者精囊和射精管病变诊断的理想手段.     

两种手术方式治疗射精管梗阻临床疗效分析*

目的比较经尿道射精管口切开术(Transurethral resection of ejaculatory ducts,TURED)与精囊腺镜下射精管内切开术治疗射精管梗阻引起的无精子症临床疗效.方法系统性回访我院于2009年7月至2012年6月住院行手术治疗并完成随访的射精管梗阻病人59人,其中 A组27人,行经尿道射精管口电切术(TURED);B组32人,行精囊腺镜下射精管内切开术.术前体检双侧睾丸正常,附睾穿刺可见成熟精子.经直肠彩超(TURS)提示双侧精囊腺均存在,同时合并射精管扩张、精囊腺囊肿等射精管梗阻的证据.精液常规均未发现精子,pH<7.1,精浆生化结果提示果糖含量明显减少.术后2~3月回访复查精液分析及并发症状况.结果在附睾炎的发生率、并发症的总发生率方面,B组较A组明显降低,差异具统计学意义(P<0.05).两者术后复查精液分析各项指标及受孕率,差异无统计学意义.结论精囊镜技术是一种安全、有效的治疗射精管梗阻的手术方式.     

Effects of hyperprolactinemia on the accessory sexual organs of the male rat

The growth-promoting effect of prolactin on the ventral prostate lobe, the anterior prostate lobe (or coagulating gland), and seminal vesicles has been studied before, during and after puberty in rats up to 5 months of age. Pituitaries from female rats were grafted under the renal capsule of 23-26-day-old male rats. Within 1/2 month substantial (five- to ten-fold) hyperprolactinemia occurred followed by a gradual decline; levels were still high 4 months after grafting. A statistically significant increase in the weight of the seminal vesicles and the ventral and anterior prostate lobes was observed 1 month after implantation. This effect was only maintained for the seminal vesicles during the next 3 months. Hyperprolactinemia did not influence testosterone metabolism. In the ventral prostate lobe, 1 month after grafting, the nuclear androgen receptor content increased, whereas the cytosolic androgen receptor content decreased. These results suggest that the growth-promoting effect of prolactin, on the ventral prostate lobe of the rat, is brought about by an increased translocation of the androgen receptor.     

Seminal fluid from men with agenesis of the Wolffian ducts: zinc-binding properties and effects on sperm chromatin stability

Zinc-binding properties were studied in 'prostatic fluid', i.e. in seminal plasma from patients with agenesis of the Wolffian ducts, and in split-ejaculate fractions dominated by seminal vesicular fluid. The effect of seminal fluid, with different zinc-binding properties, on the stability of zinc-dependent sperm chromatin was assessed by exposing sperm to 1% sodium dodecyl sulphate (SDS) for 60 min. Citrate was the only zinc ligand in 'prostatic fluid', as revealed by gel chromatography. Zinc in this fluid enhanced the stability of sperm chromatin. In contrast, the stability of sperm chromatin was decreased in seminal plasma dominated by vesicular fluid. These results are in accordance with the concept that prostatic fluid ensures the appropriate zinc content and stability of sperm chromatin, whereas abundance of vesicular fluid may jeopardize chromatin stability by reducing chromatin zinc content.     

Ectopic opening of cystic dilatation of the ejaculatory duct into enlarged prostatic utricle

A 28-year-old man was referred to our department for the management of recurrent hemospermia during the past 5 years. Genital examination and hormonal levels were normal. Semen analysis showed no change in volume and pH; however, hemospermia and asthenozoospermia were observed. Ultrasonography and computed tomography scan revealed the presence of a cystic lesion with calcification in the terminal part of seminal vesicles adjoining the prostate gland. The following vasography and endoscopic retrograde urethrography demonstrated 2 communicating cystic dilatations arising from the verumontanum. The diagnosis of cystic dilatation of the ejaculatory duct opening into an enlarged prostatic utricle was reached. Transurethral unroofing of the cyst was separately performed with a successful outcome. The characteristic of the 2 cystic dilatations was confirmed by pathologic examination. To the best of our knowledge, this is the first case of ectopic cystic dilatation of the ejaculatory duct opening into an enlarged prostatic utricle.     

输尿管镜技术在血精症诊断和治疗中的应用

目的:探讨经尿道输尿管镜技术在血精症诊断和治疗中的应用和可行性。方法:采用经尿道输尿管镜技术对43例血精症患者进行经尿道输尿管镜检查和冲洗取石,并对治疗经验进行总结,以探讨经尿道输尿管镜技术在血精症诊断和治疗中的应用价值。结果:43例检查均成功,明确了病因,进行了冲洗、取石等治疗,平均手术时间25(18~45)m in,术中、术后无明显并发症,随访1~24个月,血精完全消失35例,症状减轻者6例,无效者2例,术后性生活均正常,均无逆行感染发生。结论:应用经尿道输尿管镜技术对血精症诊断和治疗的安全性高、病因诊断率高,治疗效果好,可以同时达到检查和治疗的目的,具有很好的临床应用价值,值得在临床推广应用。     

Effect of androgen deprivation on the expression of aquaporins in rat prostate and seminal vesicles

The aim of this study was to investigate the level of secretions of prostate and seminal vesicles and its association with the expression of AQP0, 1, 4, 5, 6 and 8 in castrated rats. Eight‐week‐old male Sprague‐Dawley (SD) rats (n = 18) were randomly divided into control group, castrated rats group and castrated followed testosterone replacement group. Four weeks after surgery, the secretions and expression of AQP0, 1, 4, 5, 6 and 8 of prostate and seminal vesicles were determined. Serum testosterone was significantly lower in castrated groups than in control and testosterone replacement groups (P < 0.05). The level of prostate and seminal vesicle secretions and the expressions of AQP0, 1, 4, 5, 6 and 8 in prostate and seminal vesicles were significantly lower in castrated group than in control and castrated followed testosterone replacement groups (P < 0.05). The decreased prostatic and seminal vesicle secretions in castrated rats may be related to the decrease in AQP0, 1, 4, 5, 6 and 8 in prostatic tissue and seminal vesicles.     

Cytological Studies of Prostatic Fluids from Men with and without Abnormal Palpatory Findings of the Prostate I. Methodological Aspects

The exfoliative cytology of fluids from the prostate and seminal vesicles has been examined after staining of smears according to Papanicolaou. The specimens have been classified into three groups depending upon the number of inflammatory cells and the cytological changes observed in the various types of cells present in the fluid.
In a group of 100 men attending the clinic due to barren marriage, the cytological findings in expressed fluid were compared with the palpatory assessment of the prostate and seminal vesicles. The palpatory assessment was regarded normal in 58, uncertain in 32 and clearly abnormal in 10 men. By the cytological examination of the same group, heavy inflammatory changes were found in 13, 14 and 7 individuals respectively.
It is concluded that a careful cytological examination, including an assessment of the whole cellular pattern observed in the smears of the fluid expressed from the prostate and seminal vesicles – if performed using proper techniques for sampling, fixation and staining and interpreted by experienced cytologists – may be a useful complement to the clinical examination in the diagnosis of inflammatory diseases of the male accessory glands.     

经尿道精囊镜技术诊治血精的临床研究

目的 探讨经尿道精囊镜技术对顽固性血精的诊断和临床应用价值.方法 筛检2010年6月至2011年7月,对16例顽固性血精患者,年龄22~47岁,平均35.5±5.3岁;病程3~48个月,平均6.6±3.6个月,采用了经尿道精囊镜诊断和治疗.结果 手术全部成功,时间25~45 min,平均30.2±8.4 min,平均随访期为8.3个月(6～12个月),术后随访至今,仅1例精囊炎性出血患者术后3个月血精复发,治疗后半年内没有血精症状出现,视为治愈,本组治愈率为93.75%.结论 经尿道精囊镜检操作简单,创伤小,可作为顽固性血精的有效诊治方法.     

Cytological Studies of Prostatic Fluids from Men With and Without Abnormal Palpatory Findings of the Prostate II. Clinical Application

Exfoliative cytology of the fluid from human prostate and/or seminal vesicles has been used for diagnosis and follow-up of inflammatory conditions in these glands. Forty-one men with a barren union and obvious cytological and/or palpatory signs of inflammation of the prostate or seminal vesicles were included and three men had cytological evidence of slight inflammation. Thirty-four men had an abundance of inflammatory cells in the expressed fluid and severe inflammatory changes appeared in the epithelial cells. In a control group of 41 matched men whose wives were pregnant in the first trimester cytological evidence of inflammation was noted only in four specimens.
All men in the experimental group were treated with antibacterial drugs for two to four months, sometimes in combination with anti-inflammatory drugs. The inflammatory changes in expressed fluids disappeared in 28 of all 37 men with cytological evidence of inflammation (75.5%). The palpatory findings were also normalized in most men who had pathological changes in the prostate and/or seminal vesicles before treatment.
It is concluded that the use of exfoliative cytology enhances the accuracy of the diagnosis of inflammatory changes in the male accessory genital glands and makes the follow-up and evaluation of treatment more objective.