射精管梗阻的诊断与治疗：附5例报告

报告射精管梗阻引起的不育症５例，其主要表现为无精子或少精子症、精子活力降低以及射精量减少，其中２例有反复性泌尿系感染病史。５例均行经尿道射精管切开术，术后精液量均增多，３例精液质量恢复。并结合文献对其病因、诊断及治疗效果进行讨论，认为射精管梗阻引起的不育症应引起临床重视，经直肠Ｂ超检查是诊断射精管梗阻的有效手段，射精管切开术能有效地改善精液质量。     

经尿道射精管切开术治疗射精管梗阻性无精子症

目的探讨经尿道射精管切开治疗射精管梗阻的安全性及临床疗效。方法分析2008年1月2011年12月收治的16例射精管梗阻性无精子症患者的临床资料,常规精液分析、精浆果糖、中性a葡萄糖苷酶测定及经直肠超声予以诊断,必要时行精道造影检查确诊。16例均采用经尿道射精管切开术治疗,术后随访其疗效。结果 16例均顺利完成手术,术后随访36月,14例（87.5%）精液各项指标均有明显改善,5例（31.3%）配偶妊娠。结论经尿道射精管切开术是治疗射精管梗阻性无精子症的安全有效的方法,值得临床推广。     

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.     

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...     

经尿道射精管切开术治疗远端射精管梗阻引起的精囊囊肿

目的:进一步探讨由于射精管梗阻引起的精囊囊肿的治疗。方法:采用精液分析(包括精液的量、pH值、果糖的测定)、经直肠指检和B超检查的方法。于2005年11月～2006年12月,12例诊断为射精管梗阻引起的精囊囊肿[(2.3±1.1)cm]患者,采用经尿道电切镜切开、切除梗阻的射精管,直到见到有乳白色的精液排出的方法治疗。结果:12例精囊囊肿患者术后1、3、12个月复查囊肿明显缩小[(1.0±0.8)cm,P<0.05]。没有发现明显的并发症。10例在术后3个月复查精液时检出活精子,12例精液量手术前后分别为(1.6±0.8)ml、(3.5±1.2)ml(P<0.05)结论:经尿道电切术治疗射精管梗阻引起的精囊囊肿是一种简单、有效的方法。     

经尿道电切术治疗射精管梗阻引起的无精子症

目的进一步探讨由于射精管梗阻(EDO)引起的无精子症的治疗。方法采用精液分析(包括精液的量、pH值、果糖的测定)、经直肠指检、B超检查精囊腺,手法检查和B超检查附睾的方法诊断。于2004年11月至2006年12月,20例患者临床上诊断为因射精管梗阻引起的无精子症,采用经尿道电切术切开、切除梗阻的射精管,直至见到有乳白色、褐色、黄褐色或暗红色精液排出。结果20例无精子症患者的精液量增多,精液中出现精子,1年内精液分析连续3次正常,其中4例其配偶怀孕。5例患者术后1年复查精囊腺明显缩小。本组没有发现明显的并发症。结论经尿道电切术治疗射精管梗阻的无精子症是一种简单、有效的方法。     

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。     

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。     

膀胱尿道镜直视下精液排出状态的观察

目的:确定男性射精管开口的具体解剖部位,为临床诊疗如精囊镜检查、射精管梗阻的治疗等提供直观依据。方法:对21例(其中血尿12例、血精2例、腺性膀胱炎6例、直肠癌根治手术后不射精1例)年龄在26~47岁的患者做膀胱镜检查时,在知情同意的情况下膀胱镜尿道直视下行前列腺以及尽可能地接近精囊腺的按摩,观察按摩后排出液排出位置并行按摩后排出液的显微镜检查,发现精子的视为含有射精管排出液。结果:所有21例患者腔镜直视下前列腺按摩液和精液排出开口的具体解剖部位都在精阜上前列腺小囊开口侧方、前侧下方以及精阜的前侧方,13例患者在按摩后排出液中检查出大量精子。前列腺小囊开口没有看到任何液体(包括精液)的排出。结论:男性射精管开口位于精阜两侧、紧邻前列腺小囊开口,而非精阜上的前列腺小囊开口内。     

Transurethral resection of cystic and non-cystic ejaculatory duct obstructions

Ejaculatory duct obstructions are diagnosed in ≈ 5% of azoospermic men and can be treated by transurethral resection (TURED) or incision of the ducts. Eight patients with azoospermia and ejaculatory duct obstructions were treated by TURED after clinical examination, semen analysis, biochemical analysis of seminal plasma, endocrine analysis, transrectal ultrasonography and testicular biopsy. In 3/3 cases of cystic and in 3/5 cases of non-cystic obstruction, TURED of the stenosis was possible. During a follow-up of 12 months there was an increase in semen volume and sperm count in 3/3 and 3/5 patients, respectively. No pregnancy was achieved during the period up to 12 months. Clinical symptoms such as haemospermia and pain disappeared in all cases. In our cases and another 98 cases of ejaculatory duct obstructions documented in the literature, men of semen quality improved in 38–60% with a pregnancy rate of men 22–31% after TURED. We conclude that there is a correlation between the aetiology of ejaculatory duct obstructions and success rate of TURED.     

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.     

Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms

OBJECTIVES: To report our experience with transurethral resection of the ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction (EDO). PATIENTS AND METHODS: Before surgery, all patients complained of a decrease in the volume of their ejaculate, 14 of 15 had a non-projectile ejaculation, nine had a genitourinary infection necessitating antibiotic treatment, and five had pain with orgasm. The mean ejaculate volume and total motile sperm count was 1.1 mL and 8.1 million sperm per ejaculate. After surgery, at a mean follow-up of 2 months, 10 men reported having projectile ejaculation, and eight reported a marked improvement in their sensation of orgasm. Overall, 14 men reported a subjective improvement in their ejaculation. The average postoperative ejaculate volume was 2.3 mL and the total motile sperm count was 38.1 million per ejaculate. CONCLUSIONS: Men with symptomatic EDO who underwent TURED showed improvements in their ejaculation, sensation of orgasm, semen analysis values and fertility.     

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。     

Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment

Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.     

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...