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Yao RJ, Xiao H, Chen SS, Feng ZH, Ding YL, Chen X, Tang SX, Zhou HL. Efficacy of various surgical approaches in treating hematospermia using transurethral seminal vesiculoscopy. BMC Surg 2023; 23:385. [PMID: 38129847 PMCID: PMC10740288 DOI: 10.1186/s12893-023-02290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome. MATERIALS AND METHODS A retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy. RESULTS The total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010). CONCLUSIONS The Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.
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Affiliation(s)
- Rui-Jie Yao
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Hong Xiao
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Shu-Shen Chen
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zhi-Hao Feng
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yi-Lang Ding
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xi Chen
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Song-Xi Tang
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
| | - Hui-Liang Zhou
- Department of Andrology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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Huyghe E, Faix A, Methorst C. [Surgery to improve male fertility]. Prog Urol 2023; 33:681-696. [PMID: 38012911 DOI: 10.1016/j.purol.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND At a time when increasing attention is being paid to the limitations and risks of in vitro fertilisation techniques, surgeries to improve male fertility are attracting growing interest. METHODS Systematic review based on a Pubmed search of surgeries to improve male fertility. RESULTS Vasovasostomy (VV) gives patency rates of 70-97% and pregnancy rates of 30-76%. Vasoepididymostomy (VE) gives patency rates of 80-84%, with pregnancy rates of 40-44%. The duration of obstruction and the age of the partner are 2 predictive parameters for the occurrence of a natural pregnancy. In cases of obstructive azoospermia due to pelvic obstruction (prostatic cyst, obstruction of the ejaculatory ducts), several surgical procedures may be proposed. Transurethral resection of the ejaculatory ducts leads to an improvement in sperm parameters in 63-83% of patients, with spontaneous pregnancy occurring in 12-31% of cases. Microsurgical cure of varicocele by the subinguinal route is a benchmark technique with recurrence rates of less than 4%. It improves live birth and pregnancy rates, both naturally and by in vitro fertilization, as well as sperm count, motility and DNA fragmentation rates. CONCLUSION Whenever possible, the urologist should present the surgical options for improving male fertility to the ART team and to the couple, discussing the benefit/risk balance of the operation as part of a personalized approach.
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Affiliation(s)
- Eric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Toulouse, France.
| | - Antoine Faix
- Clinique Saint-Roch, 560, avenue du Colonel-Pavelet-dit-Villars, 34000 Montpellier, France
| | - Charlotte Methorst
- Service de médecine de la reproduction, hôpital des 4-Villes, Saint-Cloud, France
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Altered microbiota profile in seminal vesicles of men presenting with refractory hematospermia. Mol Biol Rep 2023; 50:2381-2389. [PMID: 36585555 DOI: 10.1007/s11033-022-08139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently, no recognized evidence is known about the bacterial communities found within seminal vesicles (SV) of men presenting with refractory hematospermia. METHODS AND RESULTS Fifteen male patients with refractory hematospermia or anejaculation were enrolled, and 15 SV-Infection (SV-In) samples from SV with hemorrhage and/or stones, 11 SV-Control (SV-C) samples from SV with non-infection, and 14 Urine (Urine) samples from posterior urethra were obtained via transurethral seminal vesiculoscopy. Then the high-throughput 16 S rRNA gene sequencing method was performed to characterize the microbiota profile. Finally, a total of 1535 operational taxonomic units (OTUs) were found, 1295 OTUs were shared across three groups, 7 OTUs, 45 OTUs, and 48 OTUs were unique to SV-C group, SV-In group, and Urine group, respectively. The 5 top bacterial phyla (mean relative abundance) in all samples were Firmicutes (52.08%), Bacteroidetes (21.69%), Proteobacteria (12.72%), Actinobacteria (9.64%), and Fusobacteria (1.62%), the 5 top bacterial genera in all samples were Bacteroides (9.13%), Lactobacillus (5.38%), Bifidobacterium (5.35%), Faecalibacterium (5.10%), and Allobaculum (3.34%), of which Bifidobacterium had the highest level in SV-C samples and had a significant difference (P < 0.05) across all groups. Differential analysis showed genera Leuconostoc and LachnospiraceaeFCS020group were identified as biomarkers in the SV-In microbiota. CONCLUSION Altered microbiota composition in seminal vesicles is related to refractory hematospermia in men, and the distribution of genus Leuconostoc or LachnospiraceaeFCS020group within seminal vesicles may interact with hematospermia. This study provides clues for the diagnosis and treatment of this urologic disorder.
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Ejaculatory Duct Obstruction Affects Seminal Vesicle Contractile Efficacy and Smooth Muscle Ultrastructure in a Rat Model. Andrologia 2023. [DOI: 10.1155/2023/5022466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The purpose of this study was to investigate the effects of ejaculatory duct obstruction (EDO) on contractile efficacy, smooth muscle ultrastructure, and α1A and M3 receptors of rat seminal vesicles (SVs). A total of 48 male rats, aged 14-15 weeks, were randomly divided into three groups, namely, the control, complete EDO, and partial EDO. SV tissues were collected at 4 and 8 weeks postoperatively for further experiments. Results revealed a marked reduction in SV contractile efficacy over time following obstruction in the complete EDO group. The contractile force and frequency decreased and increased in the partial EDO group at week 4, respectively, whereas contractile efficacy significantly reduced at week 8. Moreover, obstruction resulted in significant downregulation in expression of α1A and M3 proteins and mRNAs in rats from the complete EDO group over time. Rats in the partial EDO group initially exhibited an increase followed by a decrease. Analysis of the ultrastructure of SV smooth muscles confirmed the above changes. In conclusion, complete EDO can lead to a progressive decrease in contractile efficiency of SVs. On the other hand, partial EDO can first compensate for the contraction of SVs and gradually decompensate afterwards.
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Lv KL, Sun WG, Zhang TB, Zheng T, Nan YH, Liu YF, Zhou YF, Wang R. Efficacy analysis of 26 cases of ejaculatory duct obstruction treated by prostatic utricle neck endoscopy. Front Surg 2022; 9:1031739. [DOI: 10.3389/fsurg.2022.1031739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveTo evaluate the safety and efficacy of transvesical incision in the treatment of ejaculatory duct obstruction.MethodsThe clinical data of 26 male infertile patients with ejaculatory duct obstruction were retrospectively analysed at the First Affiliated Hospital of Zhengzhou University from June 2020 to August 2021. All patients were treated with seminal vesicle neck incision for ejaculatory duct obstruction. The general clinical characteristics, intraoperative conditions and postoperative effects on the patients were recorded, and the therapeutic effect was evaluated.ResultsThe ejaculatory duct was found through fenestration, and the seminal vesicle gland was smoothly entered in 25 patients (96.2%). Among them, 22 cases underwent bilateral endoscopy and three underwent unilateral endoscopy. Sperm appeared in 23 cases (88.5%) 3 months after surgery. The sperm concentration and motility postoperatively at 6 months were higher than that at 3 months postoperatively. No postoperative complications, such as epididymitis or retrograde ejaculation, occurred.ConclusionSearching for the ejaculatory duct via the neck of the prostatic utricle, assisted by a low-energy holmium laser, is a new method for the treatment of ejaculatory duct obstruction. Microscopic vision is clear using this approach and the postoperative complications are few, which has high value for clinical application.
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Mei CE, Hu JC, Li JR, Chiu KY, Wang SS, Chen CS. Intraoperative calculus or hemorrhage in transurethral seminal vesiculoscopy as a risk factor for recurrent hemospermia. PLoS One 2022; 17:e0268314. [PMID: 35789209 PMCID: PMC9255724 DOI: 10.1371/journal.pone.0268314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
We have summarized our experience regarding transurethral seminal vesiculoscopy (TUSV) and analyzed both its recurrence status and the risk factors for recurrence. From January 2010 to December 2020, 48 patients with intractable hemospermia received successful TUSV at Taichung Invalids General Hospital. Upon analysis of the intraoperative findings, the five-year disease-free Survival rates (DFS) were 74.1% in the no calculus group compared to 37.1% in the calculus group with a significant difference (log-rank p = 0.015), 75.0% in the no hemorrhage or no blood clot group compared to 43.2% in the hemorrhage or blood clot group with significant difference (log-rank p = 0.032). Univariate analysis showed intraoperative calculus (p = 0.040; HR: 2.94, 95% CI: 1.05–8.21) to be significantly associated with recurrence (p < 0.05). Patients with intractable hemospermia who were diagnosed with stones or blood clots found during TUSV experienced a higher rate of hemospermia recurrence.
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Affiliation(s)
- Cheng-En Mei
- Division of Traumatology, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ju-Chuan Hu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- * E-mail:
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Zheng T, Zhang TB, Lv KL, Nan YH, Liu YF, Hao YW, Zhang J, Wang R. A Comparative Study on the Success Rates of Two Approaches for Seminal Vesiculoscopy. Am J Mens Health 2022; 16:15579883221115615. [PMID: 35959959 PMCID: PMC9380223 DOI: 10.1177/15579883221115615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to compare the success rates of two approaches for seminal
vesiculoscopy: through the interior of the prostatic utricle and through the
neck of the prostatic utricle. The patients were divided into two groups based
on the seminal vesiculoscopy used. Group A was an interior of the prostatic
utricle group (152 cases), and group B was a neck of the prostatic utricle group
(146 cases). The general clinical data, intraoperative conditions and surgical
results of the two groups were compared. Compared with group A, group B had a
higher surgical success rate (94.5% vs. 62.5%, p < .001), a
shorter operation time (33 min vs. 45 min, p < .001), less
blood loss (0.5 ml vs. 2 ml, p < .001), a higher pain relief
rate (86.6% vs. 52.3%, p < .001), a higher remission rate of
haemospermia (82.2% vs. 58.5%, p = .011), a lower recurrence
rate of pain (10.4% vs. 35.4%, p < .001), a lower recurrence
rate of haemospermia (15.6% vs. 37.7%, p = .014), a higher
symptom remission rate of the lower urinary tract (90.9% vs. 50.0%,
p = .030), a higher remission rate of scrotal moisture
(84.6% vs. 45.5%, p = .042) and a higher remission rate of
frequent spermatorrhea (80.0% vs. 55.6%, p = .033). Seminal
vesiculoscopy undertaken through the neck of the prostatic utricle has the
characteristics of high success rate, short operation time and good surgical
effect and is worthy of promotion and application.
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Affiliation(s)
- Tao Zheng
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tian-Biao Zhang
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kun-Long Lv
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong-Hao Nan
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong-Fei Liu
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ya-Wei Hao
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Zhang
- Department of Health, North Beijing Medical District of the PLA General Hospital, Beijing, China
| | - Rui Wang
- Department of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ren J, Xing Z, Ji Y, Yang K, Gao Y, Wang W, Fan S, Wang J. Establishment of an animal model of ejaculatory duct obstruction. Andrologia 2022; 54:e14499. [PMID: 35716081 PMCID: PMC9539691 DOI: 10.1111/and.14499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to establish animal models with different degrees of ejaculatory duct obstruction. Forty-eight male rats aged 14-15 weeks were randomly divided into three groups (n = 16): control, complete ejaculatory duct obstruction (tied around the lower seminal vesicle gland and ductus deferens with a 2-0 silk ligature), and partial ejaculatory duct obstruction (padded with a wire guide). Mortality, complications, seminal vesicle morphology and histopathology were compared in the three groups at 4 and 8 weeks postoperatively. In the complete ejaculatory duct obstruction group, seminal vesicle weight decreased gradually with increased obstruction time compared with those of the control group (p < 0.05); moreover, stone-like material was occasionally observed. In the partial ejaculatory duct obstruction group, there was an increase followed by a decrease in seminal vesicle weight in the postoperative period compared with that of the control group (p < 0.05). Histopathological lesions of seminal vesicles were observed in the complete and partial ejaculatory duct obstruction groups (8 weeks postoperatively). We successfully established animal models of complete and partial ejaculatory duct obstruction, which provide an easy-to-use tool for studying seminal vesicle changes after ejaculatory duct obstruction.
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Affiliation(s)
| | | | - Yuan Ji
- Shanxi Medical University, Taiyuan, China
| | - Ke Yang
- Shanxi Medical University, Taiyuan, China
| | - Yu Gao
- Shanxi Medical University, Taiyuan, China
| | - Wei Wang
- Shanxi Medical University, Taiyuan, China
| | | | - Jingqi Wang
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, China
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Drury RH, King B, Herzog B, Hellstrom WJG. Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A Narrative Review. Sex Med Rev 2021; 10:669-680. [PMID: 37051970 DOI: 10.1016/j.sxmr.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare condition that is historically idiopathic or associated with sexual behavior. Technological advances have identified many of the etiologies behind HS, improving treatment. Though often benign, HS remains a source of considerable sexual anxiety for patients. Few papers have outlined a diagnostic and therapeutic approach to HS, and none have explicitly addressed its sexual consequences. OBJECTIVES To provide a comprehensive overview of HS, emphasizing its sexual ramifications. METHODS A PubMed literature search was performed through May 2021 to identify all relevant publications related to etiology, diagnosis, treatment, and sexual effects of HS. Original research and reviews were analyzed, and pertinent studies were included in this review. RESULTS Iatrogenic interventions (eg, transrectal ultrasound-guided prostate biopsies) are the most common cause of HS. Infection and/or nonspecific inflammation is the most common non-iatrogenic etiology. Malignancies, including prostate, testicular, and other genitourinary cancers, are rarely the cause of HS. Diagnostic approaches to HS can be organized according to patient age (less than or greater than 40 years old), persistence of bleeding, and the presence/absence of concerning symptoms. Though HS often spontaneously resolves, treatment may require various medications (eg, antibiotics, anti-inflammatories) or surgical interventions. HS has several sexual ramifications, including libido-affecting anxiety, social repercussions from sexual partners and non-sexual affiliates, increased risk of erectile dysfunction or transmission of sexual infections, and compromised fertility, especially when cryopreservation is utilized. CONCLUSION HS may significantly affect sexual health through several mechanisms, though there is a paucity of formal data on this subject. Further research is needed to fully understand the severity and extent of HS's effect on sexual well-being, especially in those with refractory bleeding. Drury RH, King B, Herzog B, et al. Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A Narrative Review. Sex Med Rev. 2021;XX:XXX-XXX.
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Affiliation(s)
- Robert H Drury
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Brendan King
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Bryan Herzog
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
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Wang XS, Li M, Shao GF, Sun WD, Zhang XL, Xiao ZY, Ma Z, Yuan MZ, Guo LQ. Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study. Asian J Androl 2021; 22:507-512. [PMID: 31898586 PMCID: PMC7523612 DOI: 10.4103/aja.aja_134_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0–97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0–18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.
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Affiliation(s)
- Xue-Sheng Wang
- Department of Urology, Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China
| | - Ming Li
- Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China
| | - Guang-Feng Shao
- Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China
| | - Wen-Dong Sun
- Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China
| | - Xiu-Lin Zhang
- Institute of Urology, Shandong University, Jinan 250033, China
| | - Zhi-Ying Xiao
- Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China.,Institute of Urology, Shandong University, Jinan 250033, China
| | - Zhen Ma
- Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China
| | - Ming-Zhen Yuan
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Li-Qiang Guo
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Yu S, Tao J, Dong B, Fan Y, Du H, Deng H, Cui J, Hong G, Zhang X. Development and head-to-head comparison of machine-learning models to identify patients requiring prostate biopsy. BMC Urol 2021; 21:80. [PMID: 33993876 PMCID: PMC8127331 DOI: 10.1186/s12894-021-00849-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023] Open
Abstract
Background Machine learning has many attractive theoretic properties, specifically, the ability to handle non predefined relations. Additionally, studies have validated the clinical utility of mpMRI for the detection and localization of CSPCa (Gleason score ≥ 3 + 4). In this study, we sought to develop and compare machine-learning models incorporating mpMRI parameters with traditional logistic regression analysis for prediction of PCa (Gleason score ≥ 3 + 3) and CSPCa on initial biopsy. Methods A total of 688 patients with no prior prostate cancer diagnosis and tPSA ≤ 50 ng/ml, who underwent mpMRI and prostate biopsy were included between 2016 and 2020. We used four supervised machine-learning algorithms in a hypothesis-free manner to build models to predict PCa and CSPCa. The machine-learning models were compared to the logistic regression analysis using AUC, calibration plot, and decision curve analysis. Results The artificial neural network (ANN), support vector machine (SVM), and random forest (RF) yielded similar diagnostic accuracy with logistic regression, while classification and regression tree (CART, AUC = 0.834 and 0.867) had significantly lower diagnostic accuracy than logistic regression (AUC = 0.894 and 0.917) in prediction of PCa and CSPCa (all P < 0.05). However, the CART illustrated best calibration for PCa (SSR = 0.027) and CSPCa (SSR = 0.033). The ANN, SVM, RF, and LR for PCa had higher net benefit than CART across the threshold probabilities above 5%, and the five models for CSPCa displayed similar net benefit across the threshold probabilities below 40%. The RF (53% and 57%, respectively) and SVM (52% and 55%, respectively) for PCa and CSPCa spared more unnecessary biopsies than logistic regression (35% and 47%, respectively) at 95% sensitivity for detection of CSPCa. Conclusion Machine-learning models (SVM and RF) yielded similar diagnostic accuracy and net benefit, while spared more biopsies at 95% sensitivity for detection of CSPCa, compared with logistic regression. However, no method achieved desired performance. All methods should continue to be explored and used in complementary ways.
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Affiliation(s)
- Shuanbao Yu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jin Tao
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Biao Dong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yafeng Fan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Haopeng Du
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Haotian Deng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jinshan Cui
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Guodong Hong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China. .,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, 450052, China.
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Han H, Lei HE, Zhang XD, Tian L. Magnetic resonance imaging compared to ultrasound as the preferred method for diagnosing intractable haematospermia. Andrologia 2021; 53:e14054. [PMID: 33955038 PMCID: PMC8244118 DOI: 10.1111/and.14054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/12/2023] Open
Abstract
We aimed to evaluate and compare the clinical diagnostic values of magnetic resonance imaging (MRI) and ultrasound in patients with intractable haematospermia. We performed a retrospective review of 23 patients with intractable haematospermia who were diagnosed with seminal vesicle haematocele and/or calculi by transurethral seminal vesiculoscopy (TSV). Patients’ demographics, disease durations, operative times, and MRI and transrectal ultrasound (TRUS) results were recorded. McNemar's test was used to compare the positive diagnostic rates of MRI and TRUS. All patients had undergone preoperative seminal vesicle MRI and TRUS to identify the aetiology of the haematospermia. The average age and disease duration were 39.3 years and 24.1 months, respectively. The mean operative time was 81.1 min. The positive result rates for MRI and TRUS were 95.7% (22/23) and 39.1% (9/23), respectively. Compared with TRUS, MRI had a significantly higher preoperative positive diagnostic rate (p < 0.01). These results suggest that MRI should be considered as a method for diagnosing intractable haematospermia in patients when TRUS findings are negative or inconclusive.
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Affiliation(s)
- Hu Han
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hong-En Lei
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dong Zhang
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Long Tian
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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13
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Achermann APP, Esteves SC. Diagnosis and management of infertility due to ejaculatory duct obstruction: summary evidence. Int Braz J Urol 2021; 47:868-881. [PMID: 33566474 PMCID: PMC8321472 DOI: 10.1590/s1677-5538.ibju.2020.0536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Arnold Peter Paul Achermann
- Departmento de Cirurgia (Disciplina de Urologia), Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,ANDROFERT, Clínica de Andrologia e Reprodução Humana, Centro de Referência para Reprodução Masculina, Campinas, SP, Brasil.,Urocore - Centro de Urologia e Fisioterapia Pélvica, Londrina, PR, Brasil
| | - Sandro C Esteves
- Departmento de Cirurgia (Disciplina de Urologia), Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,ANDROFERT, Clínica de Andrologia e Reprodução Humana, Centro de Referência para Reprodução Masculina, Campinas, SP, Brasil
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14
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Chen WK, Yu DD, Chen ZX, Li PF, Cai J, Liu YP, Wu ZG. Transurethral seminal vesiculoscopy for intractable hematospermia: experience from 144 patients. BMC Urol 2021; 21:48. [PMID: 33773582 PMCID: PMC8005245 DOI: 10.1186/s12894-021-00817-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose to describe the methodology of transurethral seminal vesiculoscopy and the anatomy of the area of the verumontanum, and to determine the safety of this procedure, especially in terms of postoperative complications. Methods This retrospective observational study enrolled 144 patients with intractable hematospermia from May 2011 and August 2019. A 4.5/6.5-Fr vesiculoscope was inserted into the seminal vesicle to deal with the positive findings. The solution of quinolones was used to rinse each seminal vesicle. Results In this study, Transurethral seminal vesiculoscopy was successfully performed in 139 patients (96.53%). Hematospermia was alleviated or disappeared in 116 (80.56%) patients by less than half a year after surgery. Common intraoperative manifestations were hemorrhage, stones, utricle polyps and cysts. The surgical approach in our study were categorized into four types, including 24 (16.7%), 73 (50.7%), 42 (29.2%), and 5 (3.5%) cases in Type A (natural opening of the ejaculatory duct), B (trans-duct fenestration), C (trans-utricle fenestration), and D (not founded), respectively. Sexual function change was recorded in 12 patients of 111 patients, all by the method of trans-utricle fenestration, including 8 (7.21%), 3 (2.70%), and 1 (0.90%) patients in shorter intravaginal ejaculatory latency time, worse erection hardness and loss of orgasm, respectively. Conclusion Transurethral seminal vesiculoscopy is an effective and safe procedure for the management of hematospermia. The anatomy of the distal seminal tract should be understood more deeply and Wu’method (uncover-curtain method) needs to be promoted to verify its universality and safety. Besides, the complications of the function dysfunction should be discussed in the future in multi-center clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00817-4.
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Affiliation(s)
- Wei-Kang Chen
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Dong-Dong Yu
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhi-Xia Chen
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Peng-Fei Li
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jian Cai
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yu-Peng Liu
- School of Public Administration and Health, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhi-Gang Wu
- Department of Andrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China. .,Reproductive Health Research Center, Health Assessment Center of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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15
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Cui B, Wu JT, Xu JJ, Ou TW. Efficacy and feasibility of day surgery using transurethral seminal vesiculoscopy under caudal block anesthesia for intractable hemospermia. Transl Androl Urol 2020; 9:2493-2499. [PMID: 33457223 PMCID: PMC7807306 DOI: 10.21037/tau-20-870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Transurethral seminal vesiculoscopy (TSV) is a safe and effective method for intractable hemospermia. It uses a natural cavity, is fast, involves little trauma, and boasts a low incidence of complications. Because uncontrollable penile erection during general anesthesia will severely influence the surgical operation or even damage the endoscope, spinal anesthesia was applied more on TSV. But spinal anesthesia extends the length of stay in the hospital and brings patients unnecessary discomfort. As the TSV is a quick recovery operation, we should think about a more suitable mode for these patients. Methods A total of 141 patients received TSV between January 2015 and July 2019: 81 patients received day surgery under caudal block (group A), and 60 received inpatient surgery under spinal anesthesia (group B). Operative time, postoperative hospital stay, hemospermia remission rate, magnetic resonance imaging (MRI) remission rate are compared. Visual analog scale (VAS) scores of groups were taken and compared at 2 time points: when there was pain during surgery (T1) and at the end of surgery (T2). Surgical methods of two groups are the same. Results The mean operative time of two groups are 34 min (group A) and 32 min (group B), and there was no statistical difference. Postoperative hemospermia remission rates are both 100% at 3 months, which at 6 months are 60% and 48%, and there was no statistical difference. MRI remission at 3 months are 72% and 57%, which has no statistical difference. Postoperative complications were mild in two groups like hematuria and dysuria which can relieve within one day, and there were no severe complications. Intraoperative pain was present in 18.5% (15/81) of group A. Their highest VAS score was 3 points, indicating mild pain, which did not influence the surgical process or postoperative recovery. The postoperative VAS scores were similar between the 2 groups. Group A did not require postoperative hospitalization, whereas the average postoperative hospitalization in group B was 2 days. Conclusions Seminal vesiculoscopy can be performed as a day surgery under caudal block, which has obvious advantages in accelerating postoperative recovery and shortening the hospital stay.
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Affiliation(s)
- Bo Cui
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiang-Tao Wu
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian-Jun Xu
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tong-Wen Ou
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
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16
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Pang K, Lou K, Huang Y, Wang H, Hao L, Shi Z, Zang G, Wei C, Chen B, Han C. Application of ultrasound-guided seminal vesicle radiography combining CT three-dimensional reconstruction technique in transurethral seminal vesiculoscopy. Andrologia 2020; 52:e13845. [PMID: 33053609 DOI: 10.1111/and.13845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 02/03/2023] Open
Abstract
For the treatment of ejaculatory duct obstruction, transurethral seminal vesiculoscopy (TSV) is the most common method, but the success rate is much lower than studies that have reported. So we developed a new ultrasound-guided seminal vesicle radiography (UGSVR) combining CT three-dimensional reconstruction (CT-TR) technique to improve the success rate of TSV. Between June 2018 and November 2019, 32 patients were enrolled and randomly assigned to two groups: experimental group (UGSvR combining CT-TR) and control group (standard evaluation). Baseline information, including age, smoking history and body mass index (BMI), was compared preoperatively. Surgical parameters included success rates (SR), surgical time (ST), catheter days (CD), length of hospital stays (HS) and complications were compared between groups. There were no statistically significant differences in baseline data between the two groups (all p > .05). There were no significant differences in the CD, HS and complications between the two groups (all p > .05), but the differences in ST and SR were statistically significant (p < .05). In conclusion, this new technique of UGSvR combining CT-TR was achieving a satisfactory increase in the success rate of TSV, while not increasing the incidence of complications, compared to normal evaluation before TSV operation.
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Affiliation(s)
- Kun Pang
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China.,Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou City, China.,College of Life Sciences, Jiangsu Normal University, Xuzhou City, China
| | - Kexin Lou
- Department of Ultrasound, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Yayong Huang
- Department of Computed Tomography, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Hao Wang
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Lin Hao
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Zhenduo Shi
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Guanghui Zang
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Cui Wei
- Department of Pediatrics, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Bo Chen
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Conghui Han
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou Central Hospital, Xuzhou, China.,Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou City, China.,College of Life Sciences, Jiangsu Normal University, Xuzhou City, China
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17
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Ren ZJ, Yang B, Lu DL, Liu SZ, Yang LC, Wang LC, Peng ZF, Liu LR, Dong Q. Transurethral resection of ejaculatory duct combined with seminal vesiculoscopy for management of persistent or recurrent hemospermia in men with ejaculatory duct obstruction. BMC Urol 2020; 20:34. [PMID: 32293392 PMCID: PMC7087380 DOI: 10.1186/s12894-020-00589-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Persistent or recurrent haemospermia often occurs in individuals with ejaculatory duct obstruction (EDO). This study aimed to evaluate the efficacy and safety of transurethral resection of the ejaculatory duct (TURED) combined with seminal vesiculoscopy in treating persistent or recurrent haemospermia in men with EDO. METHODS From June 2014 to March 2018, 103 consecutive patients with EDO who underwent TURED combined with seminal vesiculoscopy for persistent or recurrent haemospermia at the Department of Urology of West China Hospital were enrolled into this retrospective study. The patients were evaluated mainly by detailed history-taking and performing semen analysis, transrectal ultrasonography, and magnetic resonance imaging. RESULTS Among the 103 patients, 79 (76.70%) had cysts of the lower male genitourinary tract; 63 (61.17%) had blood clots; and 32 (31.07%) had calculi in the seminal vesicle and/or prostatic utricle. The duration of postoperative follow-up was 12 months, and the symptoms of haemospermia disappeared in 96 (93.20%) patients. There was no significant difference in the semen PH and sperm count before and after surgery; however, the ejaculate volume and sperm motility significantly improved postoperatively. Except for two cases of acute urinary retention and one case of watery ejaculate after surgery, no severe postoperative complications, including epididymitis, urethral stricture, urinary incontinence, retrograde ejaculation, or rectal injury, were observed. CONCLUSION TURED combined with seminal vesiculoscopy is a suitable method for the diagnosis and treatment of persistent or recurrent haemospermia in men with EDO.
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Affiliation(s)
- Zheng-Ju Ren
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Bo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Dong-Liang Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Sheng-Zhuo Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Lu-Chen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Lin Cun Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Zhu-Feng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Liang-Ren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37, Guo Xue Road, Chengdu, 610041, Sichuan Province, China.
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18
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Guiding role of seminal tract anatomical study in transurethral seminal vesiculoscopy. Wideochir Inne Tech Maloinwazyjne 2020; 15:176-184. [PMID: 32117502 PMCID: PMC7020709 DOI: 10.5114/wiitm.2019.86774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction There have been problems with low qualification operator-related complications and failures of transurethral seminal vesiculoscopy (TSV) in China. Aim To study the guiding role of seminal tract anatomical study (STAS) in TSV. Material and methods We performed STAS to study the structure, morphology, duct trajectory, and anatomical relationships between the seminal vesicles and the adjacent tissue in pelvic specimens from 12 adult cadavers. Then the surgical effects and complications of 82 cases of TSV performed by 3 doctors were retrospectively studied to compare the difference between the two groups of before and after the anatomical study. Results The anatomical studies of the 12 adult cadaveric pelvis specimens identified the lengths and widths of the right- and left-side seminal vesicles and tracts. The TSV can treat lesions located in the distal seminal tract and vesicle, but proximal lesions cannot be reached, which is an anatomical limitation of this technique. There were significant differences in the surgical times and the surgical validity rates between the 2 groups. Conclusions Our anatomical study of the seminal tract and seminal vesicles is valuable for guiding TSV in clinical practice.
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19
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Pang K, Dong BZ, Han CH. Commentary on "Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases". Asian J Androl 2020; 22:227-228. [PMID: 31187781 PMCID: PMC7155798 DOI: 10.4103/aja.aja_56_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kun Pang
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College Affiliated to Xuzhou Medical University, Xuzhou 221009, China
| | - Bing-Zheng Dong
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College Affiliated to Xuzhou Medical University, Xuzhou 221009, China
| | - Cong-Hui Han
- Department of Urology, Xuzhou Central Hospital, Xuzhou Clinical College Affiliated to Xuzhou Medical University, Xuzhou 221009, China
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20
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Mathangasinghe Y, Samaranayake UMJE, Dolapihilla BN, Anthony DJ, Malalasekera AP. Morphology of ejaculatory ducts: A systematic review. Clin Anat 2020; 33:1164-1175. [PMID: 31894887 DOI: 10.1002/ca.23557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/05/2019] [Accepted: 12/28/2019] [Indexed: 01/21/2023]
Abstract
The morphology of human ejaculatory ducts has not been well established. The objective of this study was to describe macroscopic and microscopic anatomy of ejaculatory ducts. We conducted a systematic review using MEDLINE, Scopus, PubMed, and Cochrane databases. Search terms were: "ejaculatory ducts," "seminal colliculus," "prostatic utricle," "anatomy," "histology," "radiology," and "embryology." We only included studies assessing adult (>18 years) humans published before November 1, 2019. We excluded studies describing pathological ducts and case reports. Independent authors extracted data using predefined criteria. Fourteen studies were included in the qualitative synthesis. Usually, the ejaculatory ducts entered the prostate by piercing the central part of its base. Most studies identified an anteromedial curve of the ducts at the outset within the prostate, their subsequent course being a straight path towards the seminal colliculus, their terminal parts diverging immediately before joining the prostatic urethra. However, the morphology of the terminal part of the ducts was inconsistent. The mean length of the ducts ranged from 1.4 to 2.2 cm. In conclusion, the luminal diameter gradually decreased as the ducts traveled towards the seminal colliculus. Ejaculatory ducts angulate anteromedially at their onset within the prostate and travel straight towards the seminal colliculus. Their terminal parts diverge immediately before joining the prostatic urethra. However, the reported dimensions of the ducts differ among studies.
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Affiliation(s)
- Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Dimonge J Anthony
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ajith P Malalasekera
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Zhen L, Liu X, Yegang C, Yongjiao Y, Yawei X, Jiaqi K, Xianhao W, Yuxuan S, Rui H, Wei Z, Ningjing O. Accuracy of multiparametric magnetic resonance imaging for diagnosing prostate Cancer: a systematic review and meta-analysis. BMC Cancer 2019; 19:1244. [PMID: 31870327 PMCID: PMC6929472 DOI: 10.1186/s12885-019-6434-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The application of multiparametric magnetic resonance imaging (mpMRI) for diagnosis of prostate cancer has been recommended by the European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN), and European Society of Urogenital Radiology (ESUR) guidelines. The purpose of this study is to systematically review the literature on assessing the accuracy of mpMRI in patients with suspicion of prostate cancer. METHOD We searched Embase, Pubmed and Cochrane online databases from January 12,000 to October 272,018 to extract articles exploring the possibilities that the pre-biopsy mpMRI can enhance the diagnosis accuracy of prostate cancer. The numbers of true- and false-negative results and true- and false-positive ones were extracted to calculate the corresponding sensitivity and specificity of mpMRI. Study quality was assessed using QUADAS-2 tool. Random effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) plot were performed for further study. RESULTS After searching, we acquired 3741 articles for reference, of which 29 studies with 8503 participants were eligible for inclusion. MpMRI maintained impressive diagnostic value, the area under the HSROC curve was 0.87 (95%CI,0.84-0.90). The sensitivity and specificity for mpMRI were 0.87 [95%CI, 0.81-0.91] and 0.68 [95%CI,0.56-0.79] respectively. The positive likelihood ratio was 2.73 [95%CI 1.90-3.90]; negative likelihood ratio was 0.19 [95% CI 0.14,-0.27]. The risk of publication bias was negligible with P = 0.96. CONCLUSION Results of the meta-analysis suggest that mpMRI is a sensitive tool to diagnose prostate cancer. However, because of the high heterogeneity existing among the included studies, further studies are needed to apply the results of this meta-analysis in clinic.
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Affiliation(s)
- Liang Zhen
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Chen Yegang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Yongjiao
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Xu Yawei
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Kang Jiaqi
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Wang Xianhao
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Song Yuxuan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Hu Rui
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Zhang Wei
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
| | - Ou Ningjing
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, 300211 People’s Republic of China
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22
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Liao LG, Li YF, Zhang Y, Li K, Zhu T, Li BJ, Wang Q, Liu XD, Luo Y, Zhou B, Jiang J. Etiology of 305 cases of refractory hematospermia and therapeutic options by emerging endoscopic technology. Sci Rep 2019; 9:5018. [PMID: 30903016 PMCID: PMC6430789 DOI: 10.1038/s41598-019-41123-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
To investigate the surgical outcomes of vesiculoscopy on refractory hematospermia and ejaculatory duct obstruction (EDO), the clinical data (including pelvic magnetic resonance imaging (MRI) examinations and the long-term effects of endoscopic treatment) from 305 patients were analyzed. Four main etiologic groups were found on MRI. We found that 62.0% (189/305) of patients showed abnormal signal intensity in MRI investigations in the seminal vesicle (SV) area. Cystic lesions were observed in 36.7% (112/305) of the patients. The third sign was dilatation or enlargement of unilateral or bilateral SV, which were observed in 32.1% (98/305) of the patients. The fourth sign was stone formation in SV or in an adjacent cyst, which was present in 8.5% (26/305) of the patients. The transurethral endoscopy or seminal vesiculoscopy and the related procedures, including fenestration in prostatic utricle (PU), irrigation, lithotripsy, stone removal, biopsy, electroexcision, fulguration, or transurethral resection/incision of the ejaculatory duct (TURED/TUIED), chosen according to the different situations of individual patients were successfully performed in 296 patients. Fenestrations in PU+ seminal vesiculoscopy were performed in 66.6% (197/296) of cases. Seminal vesiculoscopy via the pathological opening in PU was performed in 10.8% (32/296) of cases. TURED/TUIED + seminal vesiculoscopy was performed in 12.8% (38/296) of cases, and seminal vesiculoscopy by the natural orifices of the ejaculatory duct (ED) was performed in 2.4% (7/296) of cases. Electroexcision and fulguration to the abnormal blood vessels or cavernous hemangioma at posterior urethra were performed in 7.4% (22/296) of cases. Two hundred and seventy-one patients were followed up for 6-72 months. The hematospermia of all the patients disappeared within 2-6 weeks, and 93.0% of the patients showed no further hematospermia during follow-up. No obvious postoperative complications were observed. The transurethral seminal vesiculoscopy technique and related procedures are safe and effective approaches for refractory hematospermia and EDO.
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Affiliation(s)
- Liang-Gong Liao
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong, China
| | - Yan-Feng Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China.
| | - Yong Zhang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ke Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Tong Zhu
- Department of Urology, Suining Central Hospital, Suining, Sichuan, China
| | - Bo-Jun Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Qi Wang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xu-Dong Liu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yong Luo
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Zhou
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Jiang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
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