Diagnosis and treatment of intractable hematospermia using a mini-nephroscope under transrectal ultrasound guidance

• Main Authors: LIU Xing, LAI Junyu, KE Jingwei
• Format: Article
• Language: zho
• Published: Editorial Office of Journal of Third Military Medical University 2020-07-01
• Series: Di-san junyi daxue xuebao
• Subjects: intractable hematospermia; mini-nephroscope; transrectal color ultrasound
• Online Access: http://aammt.tmmu.edu.cn/Upload/rhtml/202001187.htm

Objective To investigate the efficacy and safety of mini-nephroscope under transrectal ultrasound guidance for treatment of intractable hematospermia. Methods We retrospectively analyzed the clinical data of 14 patients with intractable hematospermia undergoing surgical treatment between January, 2018 and June, 2019. During the surgery, the opening of the ejaculatory duct was difficult to identify in these patients, and the translucent membranous area at 5 or 7 o'clock in the lateral posterior wall of the prostate was not obvious after entering the seminal vesicle, which did not allow natural orifice surgery via the ejaculatory duct. Under TRUS guidance, the lateral posterior wall of the seminal vesicle was punctured for entry of the mini-nephroscope. Results All the 14 patients completed seminal vesicle examinations and the success rate of nephroscope entry via the seminal vesicle was 100%. The operation time was 35 (18~95) min, and the hospital stay of the patients was 3.6 (3~5) d. Ten patients were found to have old blood clot, 4 had calculi, 2 had cysts, and 1 had inflammatory polyp in the seminal vesicle; 1 patient did not show obvious abnormality in the seminal vesicle. The patients were treated by seminal vesicle flushing, expansion, holmium laser cyst decapitation and decompression, lithotripsy and polypectomy. The patients were followed up for 6~24 months, during which the symptom of hemospermia disappeared 2~4 weeks after the operation in all the patients, and 6 patients reported significant relief of ejaculation pain and pelvic floor discomfort. One patient experienced recurrence of hemospermia 6 months after the operation and was cured after conservative treatment. One patient had thin and abundant semen. None of the patients were found to have rectal injury, epididymitis, retrograde ejaculation or other complications. Conclusion TRUS-guided nephroscopy using a mini-nephroscope is safe and effective for treatment of intractable hematospermia and allows accurate puncture of the seminal vesicle to improve the success rate of the operation, avoid repeated puncture, and reduce the surgical complications