The diagnosis and treatment of recurrent hematospermia
presents significant difficulty. Although many urologists have
depended solely on transurethral ultrasonography and MRI
with an endorectal coil to evalute hematospermia, numerous
false-positive results were related to the recognized limits of
the various imaging techniques. Therefore, the limits of these
techniques have led to attempts to examine the structures using
direct observation. Several methods of endoscopic management
of hematospermia have been reported. We describe our current
techique of transutricular seminal vesiculoscopy and evaluate its
efficacy in diagnosing and treating recurrent hematospermia.
From February 2010 to July 2011, 89 patients with recurrent
hematospermia were enrolled this study. All patients performed
transurethral ultrasonography or endorectal MRI preoperatively.
When the patients experienced hematospermia for at least
three months, and failed conservative therapy consisting of oral
antibiotics for 4-6 weeks, transutricular seminal vesiculoscopy
was performed using a 4.5F rigid ureteroscope. Patients were
followed for more than 3 months after the procedures.
The mean age and duration of diseases were 39.1 years (range
20-61) and 8.3 months (range 3-125), respectively. Hemorrhage
was found in the seminal vesicles, the utricular lumen and the
ejaculatory ducts in 67 (75.3%), 10 (11.2%) and 5 (5.6%),
respectively. Calculi were present in the seminal vesicles, the
utricular lumen and the ejaculatory ducts 10 (11.2%), 8 (9.0%)
and 5 (5.6%), respectively. A midiline cyst was found at 6
cases (6.7%). Biopsy of 5 cases revealed inflammatory, with no
evident malignancy. Symptoms of hematospermia disappeared
in 72 cases (80.9%) during the follow-up period. Postoperative
complications such as epididymitis, retrograde djaculation, or
rectal injury were not observed.
Our experience has demonstrated that transutricular seminal
vesiculoscopy is safe and effective in the diagnosis and treatment
of recurrent hematospermia with minimal complications.