The Value Of Transurethral Seminal Vesiculoscopy In Diagnosis And Treatment Of The Distal Seminal Tracts Disease

Objective: Clinicians depend mainly on seminal vesiculogram(SV),transrectal ultrasound(TRUS),and magnetic resonance imaging(MRI)for the diagnosis of seminal tracts diseases before,but these means are still unable to satisfy clinical demand for diagnosis and treatment of the distal seminal tracts disease.With the development of technology and endoscopic equipment,clinical doctors began to make the diagnosis and treatment of the distal seminal tracts disease by transurethral seminal vesiculoscopy.However,the transurethral seminal vesiculoscopy as a new treatment technology,is not widely used.In this current study,we began to explore the use of transurethral seminal vesiculoscopy in the diagnosis and treatment of the distal seminal tracts disease,based on the experience of our hospital.Materials & Methods: From April March 2016 to November 2017,We retrospectively analyzed 20 cases with the distal seminal tracts diseases diagnosed and treated by the transurethral seminal vesiculoscopy in the First Affiliated Hospital of Dalian Medical University Hospital,including hematospermia,seminal vesicle stones and ejaculatory duct cyst,with hematospermia history greater than 6 months and long-term drug treatment invalid.The average age was 46.3 years(range 23-65).Preoperative examinations include blood test,coagulation function,liver and kidney function,semen routine,seminal plasma fructose,TRUS,MRI and so on.All cases used Wolf 6 Fr /7.5Fr transurethral seminal vesiculoscopy for inspection and for the further treatment.We collected the data of all the cases for statistical analysis as follows:(1)the data of TRUS and MRI with the transurethral seminal vesiculoscopy for diagnosis the disease to calculate the coincidence rate of the two means;(2)the findings and correspondingtreatment of using the transurethral seminal vesiculoscopy in patients;(3)the preoperative and postoperative clinical symptoms: such as perineal discomfort,lower urinary tract symptoms,hematospermia and so on;(4)preoperative and postoperative semen red blood cells,white blood cells,the total number of sperm and semen volume for three month.We use software SPSS20.0 data for statistical analysis.Results: The transurethral seminal vesiculoscopy performed successfully in all patients.The average time of surgery was 63.3±21.5min(35-115min).Intraoperative ejaculatory duct stenosis with guide wire expansion or holmium laser incision,cyst was cut by holmium laser,calculi was removed by holmium laser lithotripsy and stone basket,seminal vesicle in hemorrhagic fluid was rinsed clean.The average follow-up time was7.3±3.2months(3-15months).Two patients were lost to follow-up after four moths of postoperation.There was no complication such as incontinence and rectal injury,orchitis,epididymitis,retrograde ejaculation after the operation.1.The diagnosis of 20 cases: the distal of seminal tract abnormalities can be found in 10 cases of preoperative TRUS and 14 cases in seminal vesicle MRI,and the transurethral seminal vesiculoscopy detected 20 the distal of seminal tracts abnormalities cases such as seminal vesicle red jelly-like blood clots,seminal vesicle stones and ejaculatory duct cyst.TRUS coincidence rate(10/20)and MRI coincidence rate(14/20),TRUS and MRI were analyzed with the accuracy of microscopic examination of the seminal vesicle.The difference was statistically significant(P <0.05).It implies that transurethral seminal vesiculoscopy is better than TRUS and MRI in the diagnosis of distal seminal tracts disease.TRUS and MRI examination results consistent with the statistical analysis,there was no statistically significant difference between them(P > 0.05).2.The findings of operation:(1)Seminal vesicle hemorrhage: We found that the seminal vesicle hemorrhage observed in 14 patients with seminal vesicle wall scattered in multiple sites and with seminal vesicle lumen with dark red hemorrhagic fluid and blood clots via transurethral seminal vesiculoscopy,4 patients did not found by preoperative MRI,and 6 patients did not found via TRUS.(2)Stone: we saw the stonesin 4 cases by useing seminal vesiculoscopy,and only in 2 cases by using preoperative MRI,but there were no stones detected by TRUS.(3)Cyst: intraoperative findings of 3ejaculatory duct cysts and 1 prostatic utricle cyst by transurethral seminal vesiculoscopy are in consistent with the preoperative result by MRI and TRUS.(4)Lesions: There was1 patients founded with the seminal vesicle lesions in intraoperative opetation(pathological finding: inflammatory tissue),while there were no finding in the preoperative imaging examination.3.Postoperative follow-up: Hemospermia of 10 patients disappeared after operation.2 cases of perineal discomfort disappeared.2 cases of lower urinary tract symptoms disappeared after surgery.Among 4 azoospermia men,sperm can be saw in 2cases after the operation.There was 1 oligoasthenospermia patient had semen quality improvement.4.Postoperative patients have less red and white blood cells in semen than preoperative patients.The total number of sperm and semen volume increased significantly compared with preoperative patients.The difference was statistically significant(P < 0.05).Conclusions:1.Transurethral seminal vesiculoscopy is better than TRUS and MRI in the diagnosis of the distal seminal tracts disease.2.Transurethral seminal vesiculoscopy can be used for the diagnosis and treatment of the distal seminal tracts diseases.The technology has minimally invasive and less complications.It can be used as an effective surgical method for the diagnosis and treatment of the distal seminal tracts diseases,but its technology and experience are still need to improve and accumulate.