超声引导下精囊穿刺置管治疗顽固性血精

目的:探讨经直肠超声引导下经会阴精囊穿刺置管连续滴注抗生素在治疗顽固性血精的价值。方法:25例临床诊断为顽固性血精的患者,在经直肠超声实时引导下行经会阴精囊穿刺置管术,在取得精囊液后留置导管,经导管连续滴注抗生素一周。结果:25例患者均一次穿刺置管成功,其中23例完成一周治疗,2例由于导管滑脱而提早拔管。治疗后随访6个月~2年,23例血精消失(92.0%),2例复发,其中1例为提早拔管者。结论:超声引导下经会阴精囊穿刺置管滴注抗生素是一种治疗顽固性血精安全而有效的方法。     

经直肠超声引导下精囊穿刺在精囊疾病中的诊断价值

目的探讨经直肠超声(TRUS)引导下精囊穿刺对精囊疾病的诊断价值。方法28例因血精和排尿困难进行超声检查患者，平均年龄38岁，平均病程15．8个月。对超声发现精囊扩张、囊肿的患者在TRUS引导下经会阴穿刺抽吸精囊液(SVF)或囊肿液，进行细菌培养、药敏实验和细胞学检查，注射造影剂摄片。1个月后随访或重复穿刺。对含有实性成分的病变则穿刺活检进行病理学检查。结果经TRUS诊断精囊和(或)射精管异常扩张20例，精囊囊肿5例，精囊癌3例。伴精囊壁增厚6例、钙化2例，结石1例。陈旧血性液体均从扩张侧精囊内或囊肿内吸出，其中包括精囊扩张17例，共19侧，射精管扩张3例均为单侧，精囊囊肿5例有2例合并出血。细菌培养阳性17例．其中耐药菌10例，穿刺后一过性轻度血尿7例，3d内消失。随访26例，时间6～36个月。重复穿刺者19例，21侧，均为精囊炎及射精管扩张患者的抗生素灌注治疗，1次穿刺未复发6例．2次穿刺未复发3例，10例患者经3次穿刺仍未治愈。结论TRUS可直接观察精囊细微结构改变，获得纯粹的精囊液、囊肿液或进行组织活检，进一步通过细菌学、细胞学、组织病理学及造影检查对明确精囊疾病的性质具有可靠的诊断价值。对顽固性血精的治疗也有一定帮助。     

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。     

经尿道精囊镜联合非那雄胺治疗顽固性血精的疗效观察

目的:探讨经尿道精囊镜技术联合非那雄胺治疗顽固性血精的临床有效性。方法:总结分析2009年10月至2013年6月治疗的32例顽固性血精患者临床资料。所有患者经非那雄胺(5 mg/d)治疗2周后,硬膜外麻醉下Wolf F6/7.5精囊镜经尿道进行检查和治疗,术后继续应用非那雄胺(5 mg/d)治疗2周。定期随访,观察血精消失情况及有无并发症。结果:32例患者精囊镜检手术均获成功,其中单纯性精囊炎16例、精囊炎合并精囊结石10例、精囊囊肿1例、精囊息肉2例、精囊脓肿3例。精囊镜检手术时间20～51(31.0±5.2)min。1例患者术后并发急性附睾炎,经抗炎治疗好转;3例术后4周内轻度乳房胀痛不适。所有患者均无尿失禁、尿道狭窄、直肠损伤、逆行射精、性功能障碍等并发症。1例失访,31例术后随访6个月至2年,29例治愈,2例复发。结论:经尿道精囊镜联合短疗程应用非那雄胺治疗顽固性血精安全、有效。     

顽固性血精病因和治疗初探

目的 :探讨顽固性血精的病因特点和影响治疗的因素 ,评价经直肠超声 (TRUS)引导下经会阴穿刺抽吸精囊液和灌注抗生素诊治顽固性血精的有效性。　方法 :入选 12例病人 ,平均年龄 (36 .4± 10 .8)岁 ,平均病程 (13.9± 6 .4 )个月。病人先行前列腺按摩 ,取得前列腺液 (EPS)并进行细菌培养。在TRUS引导下经会阴穿刺抽吸影像异常侧精囊液 (SVF)进行细菌培养和细胞学检查。根据EPS细菌培养和药敏试验结果选择抗生素 ,如细菌培养阴性则选择广谱抗生素 ,在TRUS引导下穿刺精囊进行灌注和冲洗。 1个月后复查时如血精未消失 ,则再次穿刺灌药。以后每 3个月随访 1次。　结果 :B超发现精囊异常影像位于左侧 4例 ,右侧 3例 ,双侧 2例 ,未见异常 3例。异常影像包括 :精囊或 和射精管扩张 7例 ;精囊壁增厚 3例 ;精囊壁钙化或精囊结石 3例 ;副中肾管 (M櫣ｌｌｅｒｉａｎｄｕｃｔ)囊肿1例。 7例SVF培养阳性 :耐甲氧西林金黄色葡萄球菌 (MRSA) 4例 ,耐甲氧西林凝固酶阴性葡萄球菌 (MRCNS)、大肠埃希菌、奇异变形杆菌各 1例。此 7例病人中 5例SVF和EPS细菌培养结果相同。在TRUS引导下经会阴穿刺精囊灌注抗生素并冲洗 ,7例灌注 1次 ,5例灌注 2次。随访 10例 ,平均 (16 .7± 5 .9)个月 ,6例未复发 ,4例仍反复发作。　结论 :以     

精囊镜检诊治顽固性血精

目的探讨经尿道精囊镜检诊治顽固性血精的临床应用价值。方法回顾性分析我院自2008年9月以来开展经尿道精囊镜检诊治8例顽固性血精患者的临床资料,结合文献复习顽固性血精的治疗方法。年龄26～55岁,平均42岁,血精病程6～48个月,平均12个月,药物和物理治疗无效。采用7F输尿管硬镜行经尿道精囊镜检。结果 8例精囊镜检手术均成功,手术时间分别为20～75min,平均35min。精囊镜检示慢性炎症5例,精囊结石2例,射精管梗阻扩张1例。无尿道和精囊损伤等并发症。术后随访时间3～24个月,7例患者血精症状消失,1例术后9个月再发血精。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之一。     

经尿道精囊镜治疗顽固性血精的临床应用效果

目的 探讨精囊镜技术治疗顽固性血精的临床疗效。方法 总结北京怀柔医院2018年1月至2022年6月50例因顽固性血精行经尿道精囊镜手术治疗的患者临床资料。手术方法:精囊镜经正常射精管开口或前列腺小囊途径进入精囊腺,予以0.9%氯化钠、庆大霉素冲洗精囊腔内血块或炎性物质,合并结石者予以钬激光碎石后取出或取石网篮直接取出,合并息肉者予以切除。术后留置导尿管。结果 50例患者均一次手术成功。手术时间45～75 min,平均62.36 min。12例经射精管自然开口进镜,38例经前列腺小囊戳孔进镜。所有患者术中均见不同程度的精囊慢性炎症表现,其中45例精囊内积血,合并精囊结石16例,精囊息肉2例,前列腺黏膜出血3例。术后10例会阴区疼痛不适,4例发生膀胱刺激症状,对症治疗后症状均消失。随访6～20个月,6例出现血精复发,未进一步诊治。结论 经尿道精囊镜治疗顽固性血精创伤小、临床疗效满意,是治疗顽固性血精的有效手术方法。     

精囊镜治疗21例顽固性血精的疗效分析

目的探讨应用精囊镜治疗顽固性血精的临床疗效。方法自2011年10月至2013年2月,广东医学院第二附属医院对21例顽固性血精患者行精囊镜检查,入院前血精时间超过半年,经过中西医药物治疗和物理治疗,症状反复出现,入院后行超声及CT排除前列腺肿瘤,使用Wolf 7.5 F输尿管硬镜行精囊镜检查,术后静脉使用抗生素治疗及留置尿管。结果 21例手术均成功,其中4例需使用电切镜切开精阜暴露射精管,手术时间20~43 min,平均25 min,1例术后出现发热,无附睾炎、尿道损伤、直肠损伤、逆行性射精等严重并发症,16例在精囊镜检查后3个月内血精完全消失,3例术后使用中药及抗生素治疗后血精消失,2例仍反复血精。结论采用精囊镜对一些久治不愈的血精患者进行检查和治疗,既可以明确诊断,又可以对精囊进行冲洗,结合药物治疗,具有创伤小、效果好、并发症少等优点,是治疗顽固性血精的有效方法之一。     

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.     

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...     

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.     

Causes and Differentialdiagnosis of Hematospermia

The authors examined the most frequent causes of hematospermia on their clinical material. They describe - in the order of importance - the examinations needed to discover pathological diagnostics. They call the attention to the importance of differentiation of "clear" hematospermia and hemato-pyospermia and review the possible ways of therapy.
Ursachen und Differentialdiagnose der Haematospermie

Zusammenfassung

Anhand eigener Beobachtungen wird zur Problematik der Haematospermie Stellung genommen. Dieses Symptom gelangt nicht so häufig zur Beobachtung, allerdings stellt die Haematospermie ein Symptom dar, das sehr ernst genommen werden muß. Die Autoren unterscheiden zwischen einer „klaren” Haematospermie und einer Pyo-Haematospermie, wenn es sich zusätzlich um eine eitrige Entzündung handelt. Die für die Differentialdiagnose wichtigen einschlägigen Untersuchungsmethoden werden beschrieben. Die wesentlichen Grundsätze der Therapie werden erläutert.     

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.     

Hemangioma of the Prostatic Urethra: Hematospermia and Massive Postejaculation Hematuria with Clot Retention

The case of a 53-year-old man with hematospermia and massive postejaculation hematuria that caused urinary retention is described. This is the sixth case in the English and Japanese language literature. Cystourethroscopic examination revealed that a solitary raised tumor was present just distal to the vermontanum, and that bleeding was from its apex. Histologic examination of an excisional biopsy sample showed features compatible with hemangioma.     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

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。     

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.     

Effects of the new steroidal antiandrogen TZP-4238 on hormone-induced canine prostatic hyperplasia.

The effects of the new steroidal antiandrogen TZP-4238 on hormone-induced canine prostatic hyperplasia (BPH) were studied in comparison with those of chlormadinone acetate (CMA), a steroidal antiandrogen used in Japan. One- to 2-year-old beagle dogs were castrated and administered 75 mg/week of androstanediol (A-diol) plus 0.75 mg/week of estradiol (E2) for 25 weeks. These dogs were treated orally with placebo, 0.5 mg/kg/day of TZP-4238, 0.1 mg/kg/day of TZP-4238, and 2.5 mg/kg/day of CMA, respectively, for 21 weeks after 4 weeks treatment with A-diol plus E2. Treatment with 0.5 mg/kg/day of TZP-4238 or 2.5 mg/kg/day of CMA suppressed prostatic growth, and treatment with 0.1 mg/kg/day of TZP-4238 suppressed prostatic growth slightly. Treatment with 0.5 mg/kg/day of TZP-4238 decreased 5 alpha-reductase activity, DHT content, and nuclear androgen receptor (AR) content in the prostate, and treatment with 0.1 mg/kg/day of TZP-4238 or 2.5 mg/kg/day of CMA also decreased or tended to decrease these parameters. In conclusion, TZP-4238 and CMA were effective in inhibiting the growth of hormone-induced canine BPH, and TZP-4238 was at least 5 times more potent than CMA. TZP-4238 inhibited prostatic growth by decreasing prostatic androgen content and the androgen-AR complex. TZP-4238 decreased 5 alpha-reductase activity by prevention of the androgen action described above.     

Analysis of transrectal and suprapubic ultrasonography for prostate size evaluation

ObjectiveThe aim of this study is to evaluate the correlation between suprapubic ultrasonography (SPUS) and transrectal ultrasonography (TRUS) in the measurements of prostate dimensions and volume.Materials and methodsA total of 90 patients presenting with prostate enlargement and lower urinary tract symptoms were enrolled. All SPUS and TRUS were performed by a single experienced urologist at the same clinic visit. We analyzed the correlations of prostate volume measured by SPUS and TRUS using the Pearson correlation coefficient. Data were further analyzed in the subgroups to determine the correlation between uroflowmetry, prostate volume, postvoid residue, and prostate specific antigen level and the presence of intravesical growth.ResultsThe mean prostate volume of the 90 patients measured by SPUS and TRUS were 65.8 ± 46.5 mL and 65.4 ± 43.9 mL, respectively (r = 0.944; p < 0.001). The anteroposterior diameters had the strongest correlation among dimension measurements (r = 0.874; p < 0.001). SPUS and TRUS measurements had better correlation in the prostate size larger than 50 mL.ConclusionThere was a strong correlation of prostate sizes measured by SPUS and TRUS. We believe that SPUS can be a reliable alternative for TRUS, especially in the patients with anal diseases. It can shorten the examination time and make the patient more comfortable.