腹腔镜精囊囊肿切除术

目的:探讨腹腔镜下精囊囊肿切除术的方法及临床疗效。方法:我院近期采用腹腔镜技术对2例伴有临床症状的精囊囊肿患者实施精囊囊肿切除术。术前经超声及CT等检查明确诊断,精囊囊肿大小为3.3cm×3.7cm×2.5cm,4.1cm×4.3cm×5.3cm。结果:2例手术均顺利完成,手术时间为140、100min,术中出血约50、20ml,术后6d出院。分别随访6、7个月,患者术前症状消失,无并发症发生,复查超声,均未见囊肿复发。结论:腹腔镜下精囊囊肿切除术具有视野清晰、操作精细、创伤小、恢复快等优点,是一种安全、有效的微创手术方式。     

经膀胱途径精囊肿块切除术(附5例报告)

目的:探讨经膀胱途径在精囊疾病外科治疗中的应用。方法:本组5例男性患者,年龄45～69岁,平均51岁。临床症状:3例主要表现为尿频、尿急、排尿不畅等下尿路症状,其中1例同时伴有排便不畅,大便变细。1例因血精就诊,1例因下腹部及会阴部隐痛不适,B超检查发现右侧精囊肿块入院。病程2～18个月,平均9个月。经直肠指检、直肠B超、盆腔CT及MRI等检查诊断为左侧精囊肿块2例,右侧3例,肿块长径3～10cm,平均5cm。5例均行经膀胱途径精囊肿块切除术。结果:5例手术均获得成功,平均手术时间75min,平均出血量140ml,术后平均住院时间10d。病理报告:精囊囊肿伴感染2例,精囊囊腺瘤1例,精囊低度恶性分叶状肿瘤1例,前列腺组织1例。随访时间3～72个月,术后症状消失或明显改善。复查B超及CT未见复发。结论:经膀胱途径精囊肿块切除术,手术切口小,视野清晰,操作简便,易于开展,是精囊疾病外科治疗的有效方法。     

男性盆腔囊性疾病17例诊治分析

目的:探讨男性盆腔囊性疾病的诊断与治疗。方法:回顾性分析我院泌尿外科2003年5月~2013年5月收治的17例男性盆腔囊性疾病患者的临床资料,探讨各疾病发生机制及辅助检查的应用。结果:17例患者中,前列腺囊肿5例(直径3.0cm)、前列腺囊腺瘤2例、精囊囊肿6例、精囊脓肿2例、精囊腺癌1例、前列腺癌(PCa)伴血肿1例;8例行腹腔镜下囊肿切除术,5例行经尿道囊肿去顶术,2例行经腹囊肿切除术,2例行根治性前列腺切除术;术后随访6个月~10年,未见下尿路症状复发。结论:超声是诊断盆腔囊性疾病的重要方法,根据超声结果,适当选取CT、MRI及膀胱镜检查,可以提高诊断的正确率。当囊肿靠近前列腺尿道时,经尿道囊肿切开术疗效确切;对于靠近膀胱颈及位于精囊的囊性肿物,腹腔镜囊肿切除术为首选;当腹腔镜切除盆腔囊性肿物困难时,可行开腹手术。     

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。     

前列腺巨大结石一例报告

前列腺结石少见 ,多为散发结石 ,我们收治 1例巨大前列腺结石 ,现报告如下。患者因尿频、尿急、排尿不畅 3年 ,症状加重伴尿痛、小腹下坠胀痛 1个月 ,以前列腺占位病变于 2 0 0 2年 3月 6日收入院。查体 :直肠指诊前列腺Ⅲ°增大 ,表面欠光滑 ,质地硬 ,结节样增生。CT示前列腺明显增大约 7.5cm× 5 .0cm× 5 .0cm ,边缘不光整 ,其内见大片不规则钙化影 ,膀胱壁增厚。MRI示膀胱壁不均匀增厚 ,前列腺增大约 6 .0cm× 6 .0cm× 6 .5cm ,内见类圆形无信号区 ,中央叶信号增高 ,外围叶显示尚可 ,精囊显示不清 ,盆腔内未见肿大淋巴结。提示前列腺…     

转移性前列腺粘液腺癌1例

患者 ,男 ,33岁。因渐进性排尿困难半年余 ,伴不规则肉眼血尿 1个月于 2 0 0 1年 2月 2 1日入院。无发热、骨骼疼痛等症状。 4年前因患横结肠粘液腺癌在外院行右半结肠切除术。术后经系统化疗。体检 :直肠指检发现前列腺明显增大 ,中央沟消失 ,质坚硬 ,固定 ,于右侧叶可触及硬结。 CT示前列腺占位性病变。血清 PSA、PAP正常。胸部 X线平片腹部 B超、电子结肠镜等检查未见异常。先后两次采用“六针穿刺法”行前列腺活检均未见恶性细胞 ,遂行手术探查。术中见前列腺大小约 1 0 cm× 8cm× 7cm,质坚硬 ,固定 ,向膀胱腔后壁凸出约 6cm。因已…     

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。     

输精管异位开口于苗勒管囊肿

目的探讨输精管异位开口于苗勒管囊肿的临床特点及诊断和治疗方法。方法分析2例患者的临床资料。2例均经精道造影证实,经尿道行苗勒管囊肿切开及开窗术。结果例1左侧精道造影显示左输精管异位开口于苗勒管囊肿合并左精囊缺如;例2双侧精道造影显示左侧输精管异位开口于苗勒管囊肿合并左精囊缺如,右侧输精管末端横过异位开口于对侧,右精囊发育不良。术后2例患者精液内均出现精子,例2血精症状消失。结论输精管异位开口于苗勒管囊肿均合并同侧精囊缺如。可表现为梗阻性无精子症或血精症。精道造影是确诊的可靠方法。根据苗勒管囊肿的大小,可行囊肿切除术或切开术。手术可缓解血精等症状,但患者的生育能力不易恢复,可借助辅助生殖技术（ART）解决生育问题。     

经尿道电切术治疗成人输尿管囊肿

我院自 1 990年 1月～ 1 999年 1 2月采用经尿道电切术 (TUR)治疗输尿管囊肿 2 6例 ,疗效满意 ,现报告如下。1　资料与方法1 .1　临床资料本组 2 6例 ,男 1 5例 ,女 1 1例 ,年龄 1 9～ 53岁 ,平均 36.2岁。囊肿位于左侧 1 4例 ,右侧 9例 ,双侧 3例。其中单纯囊肿 1 9例 ,囊肿并发结石 7例。囊肿最大 4.5cm× 4.5cm,最小 0 .8cm× 0 .5cm。主要症状为无痛性肉眼血尿 7例 ,尿路刺激症状 5例 ,排尿不畅或排尿困难 4例 ,腰痛及下腹部疼痛 7例 ,体检发现 3例。其中 2 2例行 B超检查 ,1 4例诊断为输尿管囊肿 ,3例诊断为膀胱结石。 1 8例行IVU检…     

腹腔镜精囊囊肿切除术1例报告

精囊囊肿是临床少见的良性病变,我院应用腹腔镜成功治疗有临床症状的精囊囊肿1例,现报道如下.@@患者资料 男性,48岁,己婚育.因反复会阴部胀痛5年,血精6个月主诉就诊,排尿稍费力,夜尿1～2次,既往无尿急、血尿、发热等症状,无冶游史.在外院长期按"慢性前列腺炎"予抗感染、物理治疗等,出现血精后诊断为"精囊炎",给予非那雄胺、止血药物等,治疗效果均不佳.门诊直肠指检检查示前列腺左上方可触及一横径约5 cm囊性肿块,上界无法触及,表面光滑,质软,无压痛,与前列腺界限清楚.前列腺液常规检查:WBC++,RBC+++,前列腺液培养阴性.经直肠超声提示左侧精囊腺囊肿(图1),CT检查提示左侧精囊区囊性占位(图2),大小约51 mm×53 mm×44 mm,未发现泌尿系其它异常,诊断为左侧精囊囊肿收入院治疗.     

Diagnosis and treatment of seminal vesicle cysts

Aim: To deepen the understanding of patients with seminal vesicle cysts for correct diagnosis and treatment. Patients and Methods: Five patients with seminal vesicle cysts were treated over the period January 1996–May 2010. Their symptoms, diagnostic results, treatment and outcomes were analysed retrospectively. The mean age of these patients at diagnosis was 35 years (range: 20–45). Symptoms included haematospermia in three patients, urinary frequency in three patients, perineal malaise in four patients, infertility in three patients, pain after ejaculation in three patients, scrotal pain in three patients and dysuria in one patient. Cysts were palpable in four patients on digital rectal examination. All patients underwent intravenous urography and cystoscopy. Some patients received ultrasonography, computed tomography (CT) scanning, magnetic resonance imaging (MRI) or vasovesiculography. The size of the masses ranged from 3.8 cm × 3 cm × 2.6 cmto approximately 9.6 cm × 5.2 cm × 5 cm. Final open surgery consisted of vesiculectomy in two patients and laparoscopic excision of a partial seminal vesical cyst in three patients. Results: The postoperative course was uneventful, except for one patient who complained of ureter pain. All patients were free of symptoms after open surgery. Conclusions: Seminal vesicle cysts are rare, but should be considered in men with haematospermia and otherwise inexplicable bladder irritation symptoms, perineal discomfort or other genitourinary complaints of unknown aetiology. Diagnosis consists of digital rectal examination, transrectal and abdominal ultrasonography, CT scanning and MRI. Laparoscopic excision of seminal vesical cysts produced excellent results.     

Hematospermia: An investigation of the bleeding site and underlying lesions

Background : The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance.
Methods : Twenty-one patients aged 26–75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS).
Results : Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient.
Conclusion : Puncture of the seminal vesicles and/or müllerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.     

经尿道精囊镜摩西技术钬激光碎石治疗血精伴精囊结石

目的探讨经尿道精囊镜摩西技术钬激光碎石治疗血精伴精囊结石的临床效果。 方法回顾性分析成都市第二人民医院泌尿外科2018年1月至2019年3月收治的血精伴精囊结石患者11例,6例单侧,5例双侧;11例均伴有血精;会阴部不适7例,6例伴有射精痛;术中利用4.5 F精囊镜结合摩西技术钬激光碎石。 结果本组患者手术时间27~52 min,住院时间为3~5 d。术后随访6个月,11例血精伴精囊结石患者的血精全部消失,5例射精痛缓解,6例会阴部不适缓解,11例均未出现术后附睾炎、发热及全身中毒症状。 结论经尿道精囊镜技术,能直接观察精囊内部情况,并配合摩西技术钬激光碎石,使碎石过程中结石位移更小,但结石消融量显著增加,避免结石逃逸,缩短手术时间,具有安全性高、创伤小、恢复快等优点,值得临床进一步推广使用。     

Transutricular seminal vesiculoscopy in the management of symptomatic midline cyst of the prostate

Purpose

To evaluate the utility of transutricular seminal vesiculoscopy as a diagnostic and therapeutic option for symptomatic midline cyst of the prostate in patients with hematospermia and symptoms associated with prostatitis.

Materials and methods

From January 2005 to July 2013, 61 patients with symptomatic (hematospermia, pain on ejaculation, scrotal discomfort) midline cyst of the prostate, who did not improve with medication within a 4-week period, were included. Diagnosis of a midline cyst of the prostate was based on an anechoic round or spheroid-shaped lesion in the median, above the level of the verumontanum, extending into the prostatic base on transrectal ultrasonography (TRUS). All patients underwent transutricular seminal vesiculoscopy using a 9.0 Fr rigid ureteroscope and Bugbee electrode. Medical records, the Chronic Prostatitis Symptom Index (NIH-CPSI), and TRUS were used for assessment for more than 3 months after the procedure.

Results

Of the 61 patients, 32 (52.4 %) had hematospermia, 20 (32.7 %) had symptoms associated with chronic pelvic pain syndrome, such as perineal pain, scrotal discomfort, and testicular pain, and nine (14.7 %) patients had ejaculatory disturbances, such as painful or uncomfortable ejaculation and anejaculation as major complaints/symptoms. In endoscopic findings, hemorrhage was present in the dilation of the prostatic utricle and in the seminal vesicle in 11 (18.0 %) and 21 (34.4 %) of the patients, respectively. Calculi were found in the dilation of the prostatic utricle and in the seminal vesicle in 12 (19.7 %) and six (9.8 %), respectively. Hematospermia resolved in 29 of 32 (90.6 %) patients after transutricular seminal vesiculoscopy. In 29 patients with chronic pelvic pain syndrome and ejaculatory disturbances, NIH-CPSI scores improved, from 19.0 ± 3.8 to 11.8 ± 3.6 (p < 0.001), after treatment. The pain domain and quality-of-life domain scores of the NIH-CPSI were better postsurgery than presurgery (p < 0.001). Acute epididymitis, as a postoperative complication, was observed in two patients (3.3 %).

Conclusions

There are various endoscopic findings in the dilation of prostatic utricle and seminal vesicle such as hemorrhage, calculi or/and purulent material in the patients with midline cyst of the prostate. The role of transutricular seminal vesiculoscopy in reducing symptoms may be mediated through the effects of endoscopic fenestration, removal of blood clots, calculi, or whitish debris and/or electrocautery of intracystic hemorrhage. This endoscopic technique enables useful diagnostic and therapeutic approaches for symptomatic midline cysts of the prostate.

     

Endoscopic seminal vesicle stone removal

Seminal vesicle stones are extremely rare, and few cases have been reported. Treatment requires removal of the stone, generally through an open vesiculectomy. A 31-year-old man presented with perineal pain, painful ejaculation, and infertility of several years' duration. Multiple stones in the seminal vesicle duct system were diagnosed by radiologic examination. We treated the patient by seminal vesicle endoscopic stone removal, thereby obviating organ loss. The composition of the stones was whewellite. To our knowledge, this approach has not been previously reported, and our result may be encouraging for treatment of such pathologic conditions of the seminal vesicles.     

精囊镜技术在血精诊治中的应用价值

目的 探讨精囊镜技术在血精诊治中的应用价值.方法 顽固性血精患者19例,经直肠超声,精囊MRI或CT扫描等检查排除精囊肿瘤、结核、前列腺占位,行前列腺液培养加药敏试验.4.5～6.0 F输尿管镜经尿道于射精管口直视下进镜,入囊后镜检,冲洗精囊内陈旧性血块;精囊结石用钬激光碎石;切除微小息肉;喹诺酮类药物0.3g/100 ml精囊保留灌注.结果 19例患者中,18例行双侧1例行患侧精囊镜检、冲洗及药物保留灌注;5例并发精囊结石者以钬激光碎石;3例微小息肉成功切除.手术时间10～75 min,平均35 min;术中、术后无并发症发生.18例术后3个月血精完全消失,随访6～12个月,血精所致症状消失;1例术后5个月血精复发经敏感抗生素治疗后好转.结论 4.5～6 F输尿管镜经正常解剖路径行精囊镜检及相关治疗是微创、安全、有效治疗顽固性血精的方法.

Abstract：

Objective To treat hematospermia by ureteroscopy and investigate its application value for the treatment of hematospermia.Methods Nineteen patients with persistent hematospermia, TRUS,seminal vesicle MRI or CT were examined to exclude seminal vesicle tumor, tuberculosis, prostatic occupancy and preoperative prostatic fluid and drug sensitivity.Transurethral 4.5 - 6 F ureteroscopy entered through the microscopic seminal vesicle, wash of the old blood, reserved perfusion with Quinolones, and the lithoclasty on the seminal stones by holmium laser, resection of small polypi.Results The ureteroscopy was successful in 18 (95%) cases for bilateral seminal vesicle, wash and drug reserved perfusion, and one case was also successful seminal vesicle microscopy on the affected side; five cases with the seminal stones by olmium laser, three cases with small polypi by resection.The averse duration of the procedure was 35 10 -75) min.There were no compliocations during or after the operation.In 18 cases at 6 - 12 months follow-up the hematospermia and symptoms of hematospermia disappeared fully after 90 d.There was recurrence in one case which improved with anti-inflammaotry treatment.Conclusions Ureteroscopic treatment for persistent hematospermia by 4.5 - 6 F ureteroscopy through the seminal vesicle is effective and safe method and results in a micro-wound.     

Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia

The goal of this study was to explore minimally invasive transurethral imaging and surgery for the treatment of severe, persistent hematospermia in cases that were refractory to conservative treatments. The study included 43 patients (aged 22-77 years; average, 44.6 years) with long-lasting, severe hematospermia, accompanied by discomfort or pain in the lumbosacral or perineal region, dysuria, frequent micturition, decreased semen volume, and/or azoospermia. Patient symptoms had persisted for 1 to 10 years (average, 5.3 years). Computed tomography or magnetic resonance imaging of each patient was evaluated, and transurethral surgery was performed. The causes of hematospermia were identified in all 43 patients, and their ejaculatory duct obstruction or seminal vesiculitis was successfully treated. No serious intraoperative or postoperative complications occurred. Pathologic analyses revealed that all of the resected or biopsied seminal vesicle tissues had chronic nonspecific inflammation in the seminal vesicle wall, and no tumors were identified. Preoperative symptomology of hematospermia disappeared in all patients followed up for 2 to 30 months (average, 16 months). A single patient experienced recurrence at 11 months and had a second minimally invasive surgery that was curative. A total of 95.3% (41 of 43) of the patients experienced normal orgasmic intensity after surgery. Magnetic resonance imaging is a valuable and accurate diagnostic method for the identification of causative factors underlying hematospermia. Transurethral dilation of ejaculatory ducts, incision of the verumontanum or the distal end of the ejaculatory ducts, and incision or resection of the relevant cysts represent simple, safe, and reliable approaches for the management of refractory cases of hematospermia that do not respond to conservative treatments.     

Seminal vesicle amyloidosis

A case of localized amyloidosis of the seminal vesicle with hematospermia is reported. To our knowledge this is the first clinical example of this disease treated by seminal vesiculectomy. Lymphocyte transformation studies were performed to search for an immunologic cause. The incidence of this disorder and its pathogenesis are reviewed.     

经尿道精囊镜诊治顽固性或复发性血精162例临床资料分析

目的:分析经尿道精囊镜诊治顽固性或复发性血精的可行性和有效性。方法:回顾分析2007年1月至2010年7月采用经尿道精囊镜诊治的顽固性或复发性血精患者162例,患者年龄19～76岁,血精病史3个月至11年,术前均因血精就诊,均行血清PSA、经直肠前列腺、精囊腔内B超以及盆腔CT或MRI检查,常规抗生素治疗4周效果欠佳或反复发作者,收治入院,行经尿道精囊镜检查。结果:全部病例术中均可见一侧或双侧精囊中暗红色或紫红色胶浆样物质和炎性改变,所有患者均取小块组织活检,病理结果回报为精囊黏膜慢性炎性改变,15例患者另可见射精管或精囊中结石;术后平均随访时间为21.7个月(12～29个月),92.6%(150/162)的患者在术后随访中经过1～15次射精后,血精消失或减轻。1例(67岁)患者因无射精活动而无法判断,7例患者术后血精消失超过3个月后复发,4例患者术后血精症状无减轻。1例患者术后发生急性双侧附睾炎,所有病例术后未见逆行射精、尿失禁或直肠损伤等并发症。结论:经尿道精囊镜技术是可行的诊断和治疗顽固性或复发性血精的新方法。