[Effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction].

Objective: To analyze the effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction. Methods: The clinical date of 56 cases of persistent hematospermia, or azoospermia/oligoasthenozoospermia from ejaculatory duct obstruction treated with transurethral seminal vesiculoscopy between November 2013 and January 2016 in the First Affiliated Hospital of Fujian Medical University were reviewed. A total of 30 cases were persistent hematospermia for 6 months to 3 years, with no response to routine antibiotic therapy for >4 weeks; 24 cases were obstructive azoospermia; and the other 2 cases were extreme oligoasthenozoospermia. Transrectal ultrasound of the prostate and seminal vesicles, and pelvic magnetic resonance imaging (MRI) were performed before the surgery, finding seminal vesicle dilation in 28 cases, ejaculatory duct dilation in 18 cases, seminal vesicle and ejaculatory duct dilation in 7 cases, seminal vesicle dilation with ejaculatory duct cyst in 2 cases, and bilateral ejaculatory duct dilation with prostatic utricle cyst in 1 case. After the transurethral seminal vesiculoscopy, follow-up examinations were performed to assess the effectiveness of the surgery for ≥3 months. Results: The surgery was successful in all the patients, with the duration of surgery ranging from 30 to 148 minutes. Among the 30 patients with hematospermia, calculi in ejaculatory duct or seminal vesicle was found in 20 cases, while inflammation or dark red jelly-like substances in seminal vesicle was seen in all cases. In the follow-up of 9.7 months (3.0-13.0 months), hematospermia in 26 (26/30, 86.7%)patients was relieved or cured after 1-6 times of ejaculation; the other 4 (4/30, 13.3%)cases still had hematospermia. In postoperative semen analysis for the 24 cases of azoospermia from ejaculatory duct obstruction, sperms were detected in 16(16/24, 66.7%)cases, but sperms were not found after 6 months following the surgery in 1 of the 16 case, thus re-obstruction was suspected; in the other 8 (8/24, 33.3%)cases, sperms could not be found in multiple semen analyses in >12 months after the surgery. The 2 cases of extreme oligoasthenozoospermia had obvious improvement in routine semen analysis in 1 and 3 months after the surgery. Except for 1 case of scrotum swelling after surgery, no postoperative complications (retrograde ejaculation, urinary incontinence, or rectal injury) were observed. Conclusions: Transurethral seminal vesiculoscopy was an effective therapy for persistent hematospermia. More strict operation indication and careful performance are necessary for azoospermia oligoasthenozoospermia from ejaculatory duct obstruction.