Efficacy of various surgical approaches in treating hematospermia using transurethral seminal vesiculoscopy

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.

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Screening for Zinner Syndrome in Patients With a Congenitally Solitary Kidney: Lessons Learned

PURPOSE

We determined if serial screening ultrasounds are beneficial in evaluating for the development of Zinner syndrome in males with a congenital solitary kidney.

MATERIALS AND METHODS

All patients included had their congenital solitary kidney diagnosed at <20 years of age and had to be ≥20 at their last visit. Individuals were seen annually, with pelvic ultrasounds to screen for mesonephric duct cysts obtained at birth and every year of age, divisible by 5.

RESULTS

At a median follow-up of 38 years of age (range 20-57), 17% (20/121) developed Zinner syndrome, with 60% (12/20) developing clinical symptoms. The yield for screening ultrasound studies was significantly higher in patients ≤20 years of age at 3.5% (12/340), compared to 0.33% (1/296) in patients >20 years of age (P = .004). Serial ultrasounds reveal the onset of lower urinary tract and cyst-related pain symptoms are associated with the growth of the seminal vesicle cyst to ≥5 cm (P = .0198). Of symptomatic patients, 75% (8/12) had abnormal uroflows. Complete urodynamic studies revealed findings consistent with bladder outlet obstruction in 38% (3/8), equivocal for obstruction in 24% (2/8), and detrusor underactivity in 38% (3/8). Cyst excision effectively resolved voiding symptoms that were obstructive in etiology but failed to resolve symptoms in patients with detrusor underactivity.

CONCLUSIONS

Serial ultrasound evaluations reveal that cyst growth to ≥5 cm in size is highly related to the onset of clinical symptoms, with the resolution of voiding symptoms by cyst excision directly associated with urodynamic findings.

Solitary fibrous tumor of the seminal vesicle

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms with variable clinical behavior depending on age, tumor site, and size, and pathologic factors such as mitoses and necrosis. Imaging features on computed tomography (CT) or magnetic resonance imaging (MRI) are not specific, and the diagnosis relies on histopathology with immunohistochemistry. SFTs arising from seminal vesicles is rare and reported in only eight earlier cases. We discuss the clinical, histopathologic and positron emission tomography (PET) imaging characteristics of a 54-year-old patient with SFT of the seminal vesicle. The patient was treated with robot-assisted seminal vesiculotomy and is doing well on follow-up at two years.

Robot-Assisted Prostatic Utricle Reconstruction Using the Carrel Patch Principle to Preserve Fertility

BACKGROUND

Prostatic utricle (PU) with normal external genitalia is an uncommon congenital anomaly. About 14% develop epididymitis. This rare presentation should warn involvement of the ejaculatory ducts. Minimally invasive robot-assisted utricle resection is the preferred method.

OBJECTIVE

To describe a novel approach to PU, we hereby present the video of a case with PU resection and reconstruction using a Carrel patch principle to preserve fertility.

METHODS

A 5-month-old male presented with right side testicular orchitis and a large retrovesical hypoechoic cystic lesion. Urine culture was positive. He responded well to oral antibiotics. A voiding urethrocystogram confirmed a large PU. A breakthrough orchitis occurred 5 months later and the decision to proceed with surgical resection was made. Robot-assisted PU resection was performed at 13 months of age and 10 kg. Dissection of the utricle was guided with a flexible cystoscope and intraoperative ultrasound. Both vas deferens were seen draining at the neck of the PU making complete circumferential resection not feasible without compromising the integrity of both seminal vesicles and vas deferens. To preserve fertility, a PU flap including both seminal vesicles was preserved and anastomosed to the edges of the resected PU following the Carrel patch principle. Postoperative course was not complicated, and patient was discharged home on second postoperative day. A month later, exam under anesthesia, circumcision, cystoscopy, and cystogram demonstrated no contrast extravasation with otherwise normal anatomy. Foley catheter was then removed. A year after the procedure patient has been asymptomatic with no new infection recurrence and normal potty-training process.

RESULTS

Symptomatic isolated PU is an uncommon presentation. Impact of recurrent orchitis on future fertility is possible. Complete resection is difficult in cases where the vas deferens enters the PU at its base crossing the midline. Our novel approach to preserve fertility using the Carrel patch principle is feasible thanks to better visibility and exposure enhancement provided robotically. Prior open attempts demonstrated be technically difficult given the deep and anterior location of the PU. To our knowledge, this is the first time such procedure is reported. The use of cystoscopy and intraoperative ultrasonography are also valuable tools.

CONCLUSION

Reconstruction of PU is technically feasible and should be considered when risk of future infertility can be compromised. After a 1-year follow-up, it is important to continue to monitor long-term. Possible complications like fistula development, infection recurrence, urethral injury and incontinence should be thoroughly discussed with parents.

[Seminal vesiculoscopy-assisted thulium laser ablation for the treatment of ejaculatory duct obstruction: An analysis of clinical outcomes]

OBJECTIVE

To evaluate the clinical outcomes of seminal vesiculoscopy-assisted thulium laser ablation (SVS-TLA) in the treatment of oligoasthenozoospermia or azoospermia induced by ejaculatory duct obstruction (EDO).

METHODS

We retrospectively analyzed the clinical data on 42 cases of EDO-induced oligoasthenozoospermia or azoospermia in our Clinic of Andrology from April 2018 to January 2020, all definitely diagnosed and treated by SVS-TLA. We followed up the patients regularly after operation, obtained their routine semen parameters at 3, 6 and 9 months postoperatively, examined them by t-test and compared them with the baseline.

RESULTS

Operations were successfully completed in all the 42 cases, with an average surgery time of 52.7 minutes. Compared with the routine semen parameters collected 2 weeks before surgery, the semen volume, sperm concentration and total sperm motility of the patients were all significantly improved at 3, 6 and 9 months postoperatively (P < 0.01). Sperm were found in 40 cases at 3 months and in the other 2 cases at 6 and 9 months after surgery. Postoperative complications were observed in 7 cases, including epididymitis, perineal or testicular pain, and hematuria, which all disappeared after corresponding symptomatic treatment. No such serious complications as retrograde ejaculation, rectal injury, urethral stricture or urinary incontinence occurred in any of the cases after operation.

CONCLUSION

SVS-TLA is a safe and effective option for the treatment of EDO, which can significantly improve the semen quality of the patient without causing serious postoperative complications.

Unusual presentation of seminal vesicle abscess: a report of two cases

Seminal vesicle abscesses (SVA) are a rare condition, and their diagnosis is challenging with non-specific clinical presentation. Only a few cases of SVA have been published. Here we report two cases of SVA. The first one is a 58-year-old male with HIV and diabetes who presented with painful swelling in the left groin for 15 days. The second patient was a 65-year-old man who presented with painful swelling in the perineum for 15 days. Both patients were radiologically (computed tomography scan) diagnosed to have SVA. The first one was treated via surgical drainage for groin abscess and SVA was treated conservatively with intravenous broad-spectrum antibiotics. The latter was treated with SVA transurethral drainage. The pus culture showed Escherichia coli. Postoperative antibiotic therapies were contented without complications. In conclusion, although SVA may be clinically unsuspected, cross-sectional radiologic imaging findings should not be underestimated in order to promptly initiate treatment.

[Seminal vesiculoscopy: Safe and effective for the treatment of refractory hemospermia]

OBJECTIVE

To investigate the clinical effect and safety of transutricular seminal vesiculoscopy in the treatment of refractory hemospermia.

METHODS

Using 6Fr ureteroscopy through the prostatic utricle, we treated 103 cases of refractory hemospermia with distal seminal duct obstructive lesions, including 12 cases complicated by distal seminal duct cyst. We rinsed the seminal duct cavity, cleaned out the stones, removed the cyst wall with holmium laser and followed up the patients for 12 months postoperatively.

RESULTS

The operations were successfully completed in all the cases but 1 (0.9%), in which the ureteroscope failed to enter the bilateral seminal vesicles. The operation time was (47 ± 9) min. No rectal injury or acute epididymitis occurred intraoperatively, nor fever, long-term dysuria or long-term hematuria after surgery. Postoperative follow-up showed that bloody semen symptoms vanished in 93 (90.3%) of the cases, improved significantly in 4 (3.9%) and not significantly in 2 (1.9%), and 3 cases of recurrence (2.9%) were all relieved after reoperation.

CONCLUSION

Transutricular seminal vesiculoscopy has the advantages of clear anatomic vision, minor invasiveness and significant effectiveness in the treatment of refractory hemospermia. What's more, holmium laser is better than plasmakinetic resection in removal of the cyst wall.

[Surgical treatment of Zinner syndrome]

Zinners syndrome (SC) is a rare congenital disease characterized by ejaculatory duct obstruction, seminal vesicle cyst in combination with ipsilateral renal agenesis. This syndrome is due to development arrest of the Wolffian duct (mesonephros). Before the onset of sexual activity, the disease is asymptomatic. The main symptoms are nonspecific, including dysuria, urinary frequency, perineal and scrotal pain after ejaculation. A clinical case with the presentation of our own experience of surgical robot-assisted treatment of a patient with Zinners syndrome is presented in the article.

Laparoscopic surgery combined with the double-J tube implantation for the rare cystic-solid schwannoma of seminal vesicle: A Case Report and Literature Review

RATIONALE

Schwannoma is common in young and middle-aged people and occurs in the head, neck, posterior mediastinum, and retroperitoneal. Schwannoma, on the other hand, is a rare occurrence in the seminal vesicle. Early diagnosis and treatment are crucial since the disease can cause lower abdominal pain, nocturia, frequent urination, blood sperm, and other symptoms. There is no standard diagnostic or treatment guideline for seminal vesicle schwannomas currently. Therefore, the treatment experience relies on the few cases reported throughout the world.

PATIENT CONCERNS

A 45-year-old male patient discovered that the tumor beside the right side spermatophore is bigger than 3 years ago.

DIAGNOSIS

Schwannoma of seminal vesicle.

INTERVENTIONS

Ureter double-J tube implantation and laparoscopic surgery for schwannoma of seminal vesicle.

OUTCOMES

The operation process went smoothly. And the patient was no discomfort after half a year.

CONCLUSION

Schwannoma of the seminal vesicle is very rare in the clinic, and the imaging examination was not conclusive. The diagnosis mainly depends on pathological results. Surgical resection is the best treatment method for schwannoma. In surgery for schwannoma of seminal vesicle, combined with the ureter double-J tube implantation are many benefits. This case is an excellent example of the seminal vesicle schwannomas.

Intraoperative calculus or hemorrhage in transurethral seminal vesiculoscopy as a risk factor for recurrent hemospermia

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.

Zinner's syndrome, a retrospective series of three cases: different strategies to the same problem

A 106 years have passed since Zinner's syndrome was first described and current knowledge is still almost exclusively based on case reports. This article presents three patients with Zinner's syndrome with different clinical presentations and consequent different treatment options, showing the possible full spectrum of this condition. The first patient presented with storage lower urinary tract symptoms and benefited from laparoscopic removal of the seminal vesicle. The second patient has an incidental diagnosis on CT and remains asymptomatic on follow-up. The third patient presented with persistent lumbar pain and underwent open surgical removal of the seminal vesicle. The authors further present a literature review of the current knowledge on this topic, hopefully to clarify the state of art and improve the management of these patients.

Laparoscopic treatment of a giant seminal vesicle cyst with hemorrhage: A case report

RATIONALE

A seminal vesicle cyst is a benign lesion of the seminal vesicle that is usually asymptomatic. However, when a giant seminal vesicle cyst ruptures and bleeds, it can cause obvious clinical symptoms. To our knowledge, no single giant seminal vesicle cyst with hemorrhage has been reported in current studies, and surgery is the primary method to treat seminal vesicle hemorrhage with obvious symptoms.

PATIENT CONCERNS

A 31-year-old man presented with urination pain but without obvious urination frequency and urgency, dysuria, and discomfort. Rectal palpation in the chest-knee position revealed a hard mass palpable in the upper right with a smooth surface and mild tenderness, and the upper edge of the mass could not be palpated.

DIAGNOSIS

The results of the B-mode ultrasound indicated a mixed echogenic lump between the bladder and prostate, with a size of 81 × 76 mm. The computer tomography scan showed an "S" tubular lump in the right side of the pelvic cavity. The mass has a computer tomography value of 58 to 70 HU, and uneven reinforcement can be observed. On the basis of the results of the magnetic resonance imaging of the urinary bladder, the lump has T1 and T2 signals of equal lengths.

INTERVENTIONS

The patient was diagnosed with a huge right seminal vesicle cyst with hemorrhage and was treated via laparoscopic surgery.

OUTCOMES

The patient recovered quickly after the operation, and the symptoms of urination pain were significantly improved.

LESSONS

Seminal vesicle hemorrhage is clinically rare, and laparoscopic treatment is an effective and safe surgical method for the treatment of seminal vesicle cysts.

[Application of transurethral seminal vesiculoscopy in uroandrology]

With the continuous improvement of living conditions, increasing attention is being drawn to the genitourinary health of males, which has boomed the development of uroandrology in recent years. Refractory hemospermia, infertility, and perineal pain are commonly seen in some male patients, and mainly relied on medical imaging for diagnosis in the past, which, however, has a high pseudopositive rate and cannot give an etiological explanation. Patients with these diseases often adopt conservative treatments such as medication and physiotherapy, often with poor prognosis, and those suffering frequent recurrence used to be treated by transurethral resection, laparoscopic surgery or open surgery, which are now rarely employed due to their high rate of postoperative complications, slow recovery, and easy recurrence. In recent years, transurethral seminal vesiculoscopy has gained a wide application in the diagnosis and treatment of the above-mentioned uroandrological diseases and shown its advantages of high clinical effectiveness and low incidence of complications. The review updates on the indications, methods, skills and clinical application of transurethral seminal vesiculoscopy.

[Ectopic seminal tract opening in enlarged prostatic utricle: A report of 22 cases]

OBJECTIVE

To explore the diagnosis, classification and treatment of ectopic seminal tract opening in enlarged prostatic utricle (EPU).

METHODS

We retrospectively analyzed the clinical data on 22 cases of ectopic seminal tract opening in EPU confirmed by spermography, EPU open cannula angiography or intraoperative puncture of the vas deferens and treated by transurethral incision of EPU, cold-knife incision or electric incision of EPU, full drainage of the anteriorwal, and open or laparoscopic surgery from October 1985 to October 2017.

RESULTS

Five of the patients were diagnosed with ectopic opening of the vas deferens and the other 17 with ectopic opening of the ejaculatory duct in EPU. During the 3－48 months of postoperative follow-up, symptoms disappeared in all the cases, semen quality was improved in those with infertility, and 2 of the infertile patients achieved pregnancy via ICSI.

CONCLUSIONS

Ectopic seminal tract opening in EPU is rare clinically. Spermography is a reliable method for the diagnosis of the disease, and its treatment should be aimed at restoring the smooth flow of semen based on proper classification and typing of the disease.

Dr. Answer AI for prostate cancer: Clinical outcome prediction model and service

Objectives

The importance of clinical outcome prediction models using artificial intelligence (AI) is being emphasized owing to the increasing necessity of developing a clinical decision support system (CDSS) employing AI. Therefore, in this study, we proposed a “Dr. Answer” AI software based on the clinical outcome prediction model for prostate cancer treated with radical prostatectomy.

Methods

The Dr. Answer AI was developed based on a clinical outcome prediction model, with a user-friendly interface. We used 7,128 clinical data of prostate cancer treated with radical prostatectomy from three hospitals. An outcome prediction model was developed to calculate the probability of occurrence of 1) tumor, node, and metastasis (TNM) staging, 2) extracapsular extension, 3) seminal vesicle invasion, and 4) lymph node metastasis. Random forest and k-nearest neighbors algorithms were used, and the proposed system was compared with previous algorithms.

Results

Random forest exhibited good performance for TNM staging (recall value: 76.98%), while k-nearest neighbors exhibited good performance for extracapsular extension, seminal vesicle invasion, and lymph node metastasis (80.24%, 98.67%, and 95.45%, respectively). The Dr. Answer AI software consisted of three primary service structures: 1) patient information, 2) clinical outcome prediction, and outcomes according to the National Comprehensive Cancer Network guideline.

Conclusion

The proposed clinical outcome prediction model could function as an effective CDSS, supporting the decisions of the physicians, while enabling the patients to understand their treatment outcomes. The Dr. Answer AI software for prostate cancer helps the doctors to explain the treatment outcomes to the patients, allowing the patients to be more confident about their treatment plans.

Primary squamous cell carcinoma of the seminal vesicle: A case report and review of the literature

RATIONALE

Primary squamous cell carcinoma (SCC) of the seminal vesicle is extremely rare, and the clinical characteristics of this kind of malignancy are still unclear.

PATIENT CONCERNS

A 62-year-old male patient presented with complaints of sensation of rectal tenesmus and dysuria.

DIAGNOSIS

Ultrasonography suggested a hypoechoic mass behind the bladder, meanwhile, computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a 40 mm × 45 mm × 48 mm mixed solid/cystic tumorous lesion in the right seminal vesicle. Postoperative histology confirmed the diagnosis of primary SCC in the seminal vesicle.

INTERVENTION

The mass was surgically excised with a laparoscopic approach. Postoperatively, 6 cycles of chemotherapy and 50 Gy of external beam radiation were concurrently performed on this patient.

OUTCOMES

No local recurrence or distant metastasis was detected within 2 years after the surgery.

LESSONS

Primary SCC of the seminal vesicle is a rare neoplasm with a poor prognosis. Clinically, it is crucial to establish early precise diagnosis and apply multimodality treatment.

Solitary fibrous tumor of the seminal vesicle: A case report

RATIONALE

Solitary fibrous tumor (SFT) is an unusual neoplasm, especially when it originates from the seminal vesicle. Herein, we describe a case of SFT that arises from the seminal vesicle.

PATIENT CONCERNS

A 66-year-old man presented to our hospital complaining of a huge irregular tumor in his pelvis during a health checkup. He was worried that the tumor could be a malignant tumor and hence wanted to undergo further examination and therapy.

DIAGNOSIS

An inhomogeneous, mixed soft tissue tumor in the pelvis was found during computed tomography (CT) and magnetic resonance imaging. The tumor showed heterogeneous and delayed enhancement during contrast-enhanced CT. The tumor was diagnosed as a cystadenoma originated from the seminal vesicle due to its imaging features. But the pathological diagnosis was SFT that originated from the seminal vesicle.

INTERVENTIONS

Laparoscopic seminal vesicle tumor resection was performed.

OUTCOMES

There was no evidence of recurrence at the 6-month follow-up.

LESSONS

SFT in the seminal vesicle is extremely rare. It is very difficult to distinguish SFT in the seminal vesicle from the primary tumors as both have similar imaging features. We describe the tumor with SFT being considered as a differential diagnosis when the tumor is found in the seminal vesicle.

Seminal vesicle metastasis after liver transplantation for hepatocellular carcinoma: A case report

RATIONALE

Cancer recurrence and metastasis after liver transplantation (LT) is common in some hepatocellular carcinoma (HCC) patients. The most common sites of extrahepatic metastases are lung, regional lymph node, adrenal gland, and bone. To our knowledge, HCC metastasis to the seminal vesicle after LT has not been reported in the literature.

PATIENT CONCERNS

A 56-year-old Asian man presented at hospital with a 9-year history of orthotopic LT because of HCC. The patient underwent surgery and radiotherapy for HCC metastasis to adrenal gland and 1 year later, chemotherapy for peritoneal metastasis. A few months later, the patient presented with computed tomography (CT) image showing masses in right lobe of liver, seminal vesicle, and space occupying mass between the spleen and stomach.

DIAGNOSES

Combination of clinical and pathological features revealed the seminal vesicle mass as metastasis from HCC.

INTERVENTIONS

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for liver and seminal vesicle lesions was performed and the postoperative pathology revealed malignancy. Thus, the patient underwent surgery and the diagnosis of seminal vesicle metastasis of HCC was confirmed by pathology and immunohistochemical analysis.

OUTCOMES

The patient died due to systemic failure.

LESSONS

Seminal vesicle metastasis from HCC after LT is rare and there is no consensus on its treatment. Further research into the pathogenesis and therapy of seminal vesicle from HCC after LT is needed to improve outcomes in the rare disease.

[Congenital seminal vesicle cysts in children]

The article reports two cases of seminal vesicle cysts with ipsilateral renal agenesis in children. The congenital nature of this condition, characteristic features of the clinical manifestation of seminal vesicle cysts makes it difficult to recognize this rare genitourinary disease. Using current methods of diagnosis and surgical treatment result in successful outcomes.

[Microsurgical management of obstructive azoospermia: Progress and prospects]

In the past two decades, with the rapid development of assisted reproductive technology and particularly the technological advances in male infertility microsurgery, many obstructive azoospermia-related infertile couples can now acquire the chances of natural pregnancy via reconstruction of the seminal tract. This article highlights the latest advances in surgical reconstruction of the seminal tract for the treatment of obstructive azoospermia, such as the application of laparoscopic and robotic techniques, with a discussion on microsurgical epididymal sperm aspiration and preservation, potential use of absorbable sutures or the bio-suture tape for microsurgical anastomosis in the management of obstructive azoospermia.

[Clinicopathological features of primary seminal vesicle adenocarcinoma: A report of 4 cases and review of the literature]

OBJECTIVE

To investigate the clinicopathological characteristics, diagnosis, and treatment of primary seminal vesicle adenocarcinoma (SVAC).

METHODS

We analyzed the clinical data and clinicopathological characteristics of 4 cases of primary SVAC treated in the Department of Urology of the Second Hospital of Tianjin Medical University and reviewed relevant literature.

RESULTS

All the 4 patients were treated by open radical resection of the seminal vesicle and prostate and pathologically diagnosed with SVAC. Preoperative prostatic biopsy had shown 1 of the cases to be negative, while preoperative CT and transrectal ultrasound had revealed a huge pelvic cystic neoplasm in another patient. Immunohistochemistry manifested that the 4 cases were all negative for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and cytokeratin 20 (CK20), but positive for cancer antigen 125 (CA125) and CK7. All the patients recovered smoothly after surgery and experienced no recurrence or metastasis during 154, 41, 20, and 12 months of follow-up.

CONCLUSIONS

Primary seminal vesicle carcinoma is extremely rare and presents in an advanced stage. Immunohistochemistry plays a valuable role in its differential diagnosis. Various combinations of radical surgery, radiotherapy, androgen-deprivation therapy, and chemotherapy are recommended for the treatment of the disease.

Tissue Sources for Accurate Measurement of Germline DNA Genotypes in Prostate Cancer Patients Treated With Radical Prostatectomy

BACKGROUND

Benign tissue from a tumor-containing organ is commonly the only available source for obtaining a patient's unmutated genome for use in cancer research. While it is critical to identify histologically normal tissue that is independent of the tumor lineage, few additional considerations are applied to the choice of this material for such measurements.

METHODS

Normal formalin-fixed, paraffin-embedded seminal vesicle, and urethral tissues, in addition to whole blood, were collected from 31 prostate cancer patients having undergone radical prostatectomy. Genotype concordance was evaluated for DNA from each tissue source in relation to whole blood.

RESULTS

Overall, there was a greater genotype call rate for DNA derived from urethral tissue (97.0%) in comparison with patient-matched seminal vesicle tissues (95.9%, P = 0.0015). Furthermore, with reference to patient-matched whole blood, urethral samples exhibited higher genotype concordance (94.1%) than that of seminal vesicle samples (92.5%, P = 0.035).

CONCLUSIONS

These findings highlight the heterogeneity between diverse sources of DNA in genotype measurement and motivate the consideration of normal tissue biases in tumor-normal analyses. Prostate 77: 425-434, 2017. © 2016 Wiley Periodicals, Inc.

[Ejaculatory duct dilation combined with seminal vesicle clysis for refractory hematospermia: A report of 32 cases]

OBJECTIVE

To evaluate the effect of ejaculatory duct dilation combined with seminal vesicle clysis in the treatment of refractory hematospermia.

METHODS

Using ureteroscopy, we treated 32 patients with refractory hematospermia by transurethral dilation of the ejaculatory duct combined with clysis of the seminal vesicle with diluent gentamicin.

RESULTS

The operation was successfully accomplished in 31 cases, with the mean operation time of 32 (26－47) minutes. The patients were followed up for 6－39 (mean 23.6) months. No complications, such as urinary incontinence and retrograde ejaculation, were found after operation. Hematospermia completely disappeared in 27 cases, was relieved in 1, and recurred in 3 after 3 months postoperatively. Those with erectile dysfunction or mental anxiety symptoms showed significantly decreased scores of IIEF-Erectile Function (IIEF-EF) and Self-Rating Anxiety Scale (SAS).

CONCLUSIONS

Ejaculatory duct dilation combined with seminal vesicle clysis under the ureteroscope, with its the advantages of high effectiveness and safety, minimal invasiveness, few complications, and easy operation, deserves general clinical application in the treatment of refractory hematospermia.

[Management of High-Risk Prostate Cancer and Left Ectopic Ureter Inserting into Seminal Vesicle with Ipsilateral Hypoplastic Kidney of a Young Patient : A Case Report]

A 44-year-old male patient visited our hospital with a chief complaint of macroscopic hematuria. Prostate biopsies were performed due to prostate specific antigen (PSA) 11.6 ng/ml, and he was diagnosed with Gleason score 5＋4 prostate cancer. Computed tomography showed a left hypoplastic kidney. T2- weighted magnetic resonance imaging showed the left ureter stump with ectopic insertion into the dilated left seminal vesicle. He was diagnosed with high-risk prostate cancer and left ectopic ureter inserting into the seminal vesicle with ipsilateral hypoplastic kidney. Laparoscopic left nephroureterectomy and open radical prostatectomy were performed.

[Transurethral seminal vesiculoscopy for the treatment of vesiculitis with hemospermia:A report of 64 cases]

OBJECTIVE

To explore the treatment of vesiculitis with hemospermia by transurethral seminal vesiculoscopy.

METHODS

We treated 64 cases of vesiculitis with hemospermia by transurethral seminal vesiculoscopy. During the operation,we removed the stones and inflammatory substances and collected seminal vesicle fluid to be cultured for bacteria,ureaplasma urealyticum(UU),chlamydia trachomatis(CT),and mycoplasma hominis(MH),followed by infusion of levofloxacin at 0. 3 g/100 ml into the seminal vesicle. Regular follow-up was conducted post-operatively.

RESULTS

All the operations were successfully accomplished, the operation time averaging(40 ± 15) min(25- 50 min). The ejaculatory duct opening was observed on the verumontanum surface in the posterior urethra in 2 cases, abnormal passages found in the prostatic utricle in 8 cases, and seminal vesicle fenestration from the prostatic utricle conducted in the other 54 cases(32 by seminal vesiculoscopy and 22 with holmium laser). Stones were seen in the prostatic utricle in 5 cases, in the seminal vesicle in 6 cases, and in both the prostatic utricle and seminal vesicle in 2 cases. Culture of the seminal vesicle fluid showed the acinetobacter to be positive in 1 case and UU, CT, and MH to be negative. At 3 months after surgery, hemospermia was cured in 52 cases, relieved in 8,and unimproved in 4.

CONCLUSION

Seminal vesicle fenestration drainage by transurethral seminal vesiculoscopy for the treatment of vesiculitis with hemospermia has the advantages of short operation time, high effectiveness and no obvious complications and can also be employed for the examination of the seminal vesicle as well as removal of stones and inflammatory substances.

Radical Prostatectomy versus External Beam Radiotherapy for cT1-4N0M0 Prostate Cancer: Comparison of Patient Outcomes Including Mortality

Background

Although radical prostatectomy (RP) and external beam radiotherapy (EBRT) have been considered as comparable treatments for localized prostate cancer (PC), it is controversial which treatment is better. The present study aimed to compare outcomes, including mortality, of RP and EBRT for localized PC.

Methods

We retrospectively analyzed 891 patients with cT1-4N0M0 PC who underwent either RP (n = 569) or EBRT (n = 322) with curative intent at our single institution between 2005 and 2012. Of the EBRT patients, 302 (93.8%) underwent intensity-modulated radiotherapy. Primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Related to these, other-cause mortality (OCM) was also calculated. Biochemical recurrence-free survival was assessed as a secondary endpoint. Cox proportional hazards model was used for multivariate analysis.

Results

Median follow-up durations were 53 and 45 months, and median ages were 66 and 70 years (P <0.0001), in the RP and EBRT groups, respectively. As a whole, significantly better prognoses of the RP group than the EBRT group were observed for both OS and CSS, although OCM was significantly higher in the EBRT group. There was no death from PC in men with low and intermediate D’Amico risks, except one with intermediate-risk in the EBRT group. In high-risk patients, significantly more patients died from PC in the EBRT group than the RP group. Multivariate analysis demonstrated the RP group to be an independent prognostic factor for better CSS. On the other hand, the EBRT group had a significantly longer biochemical recurrence-free survival than the RP group.

Conclusions

Mortality outcomes of both RP and EBRT were generally favorable in low and intermediate risk patients. Improvement of CSS in high risk patients was seen in patients receiving RP over those receiving EBRT.

The Use of Unidirectional Barbed Suture for Urethrovesical Anastomosis during Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis of Efficacy and Safety

Background

Unidirectional barbed suture (UBS) has been widely used for surgery in recent years, especially for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). However, the efficacy and safety comparing it with conventional non-barbed suture (CS) for UVA is still controversial.

Aims

The objective of this study is to assess the current evidence regarding the efficacy and safety of UBS compared with CS for UVA during RARP.

Methods

We comprehensively searched PubMed, Embase, The Cochrane Library, SinoMed (Chinese) and other databases on Oct. 9, 2014 to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) and other comparative studies evaluating these two types of suture. The outcome measures included anastomosis time operative time, posterior reconstruction (PR) time, postoperative leakage (PL) rate and continence rates at different time points (4-6 weeks, 3 months, 6-12 months) after surgery. Secondary outcomes included estimated blood loss (EBL) and length of catheterization (LOC).

Results

Three RCTs and six observational studies including 786 cases were identified. Meta-analysis of extractable data showed that use of UBS could significantly reduce anastomosis time (weighted mean difference [WMD]:-3.98min; 95% confidence interval [CI], -6.02 -1.95; p = 0.0001), operative time (WMD:-10.06min; 95% CI, -15.45–-4.67; p = 0.0003) and PR time (WMD:-0.93min; 95% CI, -1.52–-0.34; p = 0.002). No significant difference was found in PL rate, EBL, LOC, or continence rates at 4-6 weeks, 3 months and 6–12 months after surgery.

Conclusions

Our meta-analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time, operative time, PR time, but also equivalent PL rate, EBL, LOC, and continence rates at 4-6 weeks, 3 months and 6-12 months after surgery. For the inherent limitations of the eligible studies, future more persuasive RCTs are needed to confirm and update our findings.

Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct

OBJECTIVE

To report one case of advanced fibrous pseudotumour.

METHODS

A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study.

RESULTS

The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia.

CONCLUSION

Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment.

[Transurethral seminal vesiculoscopy for refractory or recurrent hemospermia: clinical analysis of 162 cases]

OBJECTIVE

To investigate the feasibility and effect of transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory or recurrent hemospermia.

METHODS

We retrospectively analyzed 162 cases of refractory or recurrent hemospermia examined and treated by transurethral seminal vesiculoscopy. The patients ranged in age from 19 to 76 years and had a hemospermia history of 3 months to 11 years, admitted due to poor therapeutic results or recurrence after 4 weeks of antibiotic medication. All the patients underwent serum PSA examination, transrectal ultrasonography, seminal vesicle ultrasonography and pelvis CT or MRI before surgery.

RESULTS

Wine- or magenta-colored colloid and inflammation were found in one or both sides of the seminal vesicle in all the cases. Pathological biopsy revealed chronic inflammatory mucosa of the seminal vesicle in all the patients, and even calculi in the ejaculatory duct or seminal vesicle in 15 cases. Postoperative follow-up averaged 21.7 (12 -29) months. Hemospermia disappeared or was alleviated in 150 (92.64%) of the cases after 1-15 ejaculations, in which 7 experienced recurrence 3 months later. Four cases failed to respond, and 1 developed acute bilateral epididymitis after surgery. No such complications as retrograde ejaculation, urinary incontinence or rectal injury were observed postoperatively.

CONCLUSION

Transurethral seminal vesiculoscopy is a safe, effective and feasible new method for the treatment of refractory or recrudescent hemospermia.

Malacoplakia of the seminal vesicles. Case report and particularities

OBJECTIVE

Malacoplakia is a rare chronic granulomatous disorder that mostly affects the urogenital system. This article describes a case of uncommon location of this disease at the level of the seminal vesicles and the clinical, imaging and histological particularities of this medical entity.

METHOD

We report the case of a 69 year-old male consulting for constitutional syndrome that presented a pelvic tumor on the image studies, possibly arising in the seminal vesicles.

RESULTS

The diagnosis was made after performing transrectal ultrasound and seminal vesicles biopsy by the pathognomonic histological findings of Michaelis Gutmann bodies. The presence of E. Coli in urine culture in our patient justified the use of a long-term antibiotic therapy such as quinolones with very good results.

CONCLUSION

Malacoplakia of the seminal vesicles is an extremely rare condition, sometimes with non-specific clinical presentation. Its diagnosis is histological and it has good response to prolonged antibiotic therapy with a benign outcome.

Urogenital sinus cyst in a 21-year-old man

We report a case of a rare congenital malformation, a urogenital sinus cyst in a young patient with non-specific symptoms for several months. A 21-year-old male presented with vague and intermittent abdominal pain. Ultrasound scan showed a retrovesical hypoechoic collection (approximately 6 cm) and left renal agenesis, compatible with a possible congenital malformation. These findings were confirmed by MRI. A laparoscopic excision of the cyst was performed with no complications. Pathology report confirmed a urogenital sinus cyst. The postoperative recovery was uneventful and the patient was discharged within 48 h. Urogenital sinus cysts are rare entities with few cases described in the literature. Imaging techniques such as ultrasound, CT or MRI may help with diagnosis. Therapeutic modalities range from observation to needle aspiration or surgical removal. In our case, we chose a laparoscopic approach to minimize morbidity and achieve an early recovery.

[Modified method of retropubic prostatectomy (RMAPE method)]

The article presents the results of the examination and treatment of 125 patients with benign prostatic hyperplasia who underwent surgery in the urological clinic of RMAPE. Retropubic adenomectomy according to the method proposed by the Clinic of Urology and Surgical Andrology of RMAPE was performed in 83 patients, and 42 patients underwent transvesical adenomectomy. In accordance with a number of parameters (timing of surgery, frequency of intra- and postoperative complications, extent of blood loss, duration of bladder drainage, length of hospital stay), a modified method of retropubic prostatectomy demonstrated significantly better results than transvesical adenomectomy.

[On the question of the so-called gold standard of surgical treatment of benign prostatic hyperplasia]

The article presents the comparative analysis of results of surgical methods used for the treatment of patients with BPH. The standardization of surgical TURP interventions as the "gold standard" in comparison with transvesical extraurethral adenomectomy is estimated. After TURP, according to the data from domestic and foreign authors, taking into account own author's data, complications develop in 28.7 to 100% cases after non-radical removal of adenomatous (hyperplastic) tissue, and only in 5.6% of cases after radical extraurethral prostatectomy. Thus, open transvesical or retropubic extraurethral adenomectomy is considerably superior to "closed" transurethral resection of the prostate as consistent with immediate and long-term results.

Transurethral seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle stones

BACKGROUND

Seminal vesicle stones are one of the main causes of persistent hemospermia. Treatment requires removal of the stone, generally through open vesiculectomy. The purpose of this study was to apply a transurethral seminal vesiculoscopy for diagnosis and treatment of the seminal vesicle stones with an ureteroscope. We assessed whether this transurethral endoscopic technique is feasible and effective in the diagnosis and treatment of the seminal vesicle stones with intractable hemospermia.

METHODS

Totally 12 patients with intractable hemospermia underwent transurethral seminal vesiculoscopy through the distal seminal tracts using a 7.3-French rigid ureteroscope. Age of patients ranged from 25 to 57 years (mean age (43.7 ± 10.5) years). The patients' symptoms ranged in duration from 4 to 180 months (mean duration (47.8 ± 45.3) months). All patients underwent transrectal ultrasonography, pelvic computed tomography or magnetic resonance imaging before the operation. Positive imaging findings were observed in patients with seminal vesicle stones and dilated seminal vesicle size. A 7.3-French rigid ureteroscope entered the lumen of the verumontanum, and then the seminal vesicle under direct vision. Seminal vesicle stones were found unilaterally in 11 cases and bilaterally in one case.

RESULTS

All 12 patients successfully underwent transurethral seminal vesiculoscopy. The seminal vesicle interior with single or multiple yellowish stones ranging from 1 to 5 mm in diameter was clearly visible. All the stones were easily fragmented and endoscopically removed using a grasper. The operative time was 30 to 120 minutes (mean (49 ± 22) minutes). The mean follow-up period was (6.9 ± 3.0) months (range 3-13 months). Symptoms of hemospermia disappeared after one month in 10 patients and after three months in two patients. Three patients with painful ejaculation could completely be relieved postoperation. There was also improvement in one patient with erectile dysfunction. There were no postoperative complications.

CONCLUSIONS

Transurethral seminal vesiculoscopy is safe and effective in the diagnosis and treatment of seminal vesicle stones. This endoscopic technique can be performed with minimal complications.

[A case of low anterior resection combined with resection of the prostate seminal vesicle urethra for douglas' pouch metastasis of the colon cancer]

A-71-year-old man with sigmoid colon cancer underwent sigmoidectomy in 2004. Ascites cytology was positive. He had a postoperative chemotherapy, but cancer recurred on the Douglas' pouch in the first year after the surgery. After chemoradiation, he underwent a low anterior resection with combined resection of the prostate seminal vesicle urethra in 2005. Four years after the recurrence, metastasis of the right lung S9 occurred, and he underwent right lower lobectomy. One year later, metastasis of the left lung S6 occurred, he underwent a partial resection of S6. Later a local recurrence has not been observed. Among the colon cancer recurrence, we think the surgery was effective for local recurrence disease with adequate observation.

Clinical presentations of schistosoma hematobium: three case reports and review

Urinary schistosomiasis is a prevalent parasitic infection in certain areas of Africa and the Middle East. It could present with common as well as unusual urological symptoms, which poses a considerable diagnostic challenge in countries where there is relative low incidence of the disease. We describe three unusual cases of urinary schistosomiasis identified in patients presenting to a London hospital. One patient was found to have schistosomiasis in the seminal vesicles following surgery for prostatic adenocarcinoma. Another was found to have schistosoma-related granulomatous inflammation within a urachal cyst. Thirdly a patient was found to have simultaneous occurrence of transitional cell carcinoma and schistosomiasis of the bladder. We review the literature on the presentations of the parasite and its association with malignancy. In conclusion, awareness of the disease prevalence, clinical and histopathological features will help to avoid missing the diagnosis.

Primary extraskeletal osteosarcoma of the seminal vesicle: a case report and literature review

A primary extraskeletal osteosarcoma (EOS) is a rare tumour. An EOS of the seminal vesicle has not been reported in the literature. We describe a case of a seminal vesicle EOS initially detected as a pre-rectal mass on a routine transrectal ultrasound in a 48-year-old man. A computed tomography (CT) scan confirmed the tumour to be arising from the left seminal vesicle. A robot-assisted laparoscopic seminal vesiculectomy was performed to avoid neurovascular bundle injury. Microscopic examination of the resected specimen showed a poorly differentiated osteosarcoma originating from the seminal vesicle. The patient received adjuvant chemotherapy. He is doing well without voiding or erectile dysfunction and he is tumour-free five months after surgery.

Validation of pre- and postoperative nomograms used to predict the pathological stage and prostate cancer recurrence after radical prostatectomy: a multi-institutional study

PURPOSE

To validate the preoperative and postoperative predictive tables of Johns Hopkins hospital, Baltimore, Maryland (JHH) and the prostate nomograms of Memorial Sloan Kettering Cancer Center, New York (MSKCC), most commonly used to predict the pathological tumor stage and postoperative freedom from recurrence, in a mixed cohort of Bulgarian prostate cancer patients.

METHODS

Clinical and laboratory data of 282 prostate cancer patients, who underwent radical prostatectomy, were supplied from three different institutions in Bulgaria. Preoperative prostate specific antigen (PSA) values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each center and evaluated. Nomogram-predicted probabilities for the presence of unfavorable pathological parameters (extracapsular extension, seminal vesicle invasion/SVI, and lymph node involvement/LNI), and the 5-year freedom from recurrence were compared with actual patient outcomes. Areas under the receiver operating characteristic (ROC) curves (AUC) were determined for each variable to assess the predictive accuracy of the nomograms applied.

RESULTS

The MSKCC prostate cancer nomograms showed superior accuracy for all parameters studied, as compared with the JHH predictive tables. AUC values for organ-confined disease (OCD), SVI and LNI were calculated as 0.763, 0.750, 0.756 and 0.868, 0.787, 0.874 for JHH and MSKCC nomograms, respectively. The AUC values for 5-year freedom from recurrent disease were 0.751, 0.812, 0.813 and 0.894 for pre- and postoperative JHH and MSKCC nomograms, respectively.

CONCLUSION

Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. All studied nomograms showed reasonable predictive values for the fi nal pathological features, like OCD, SVI and LNI, and for the 5-year freedom from recurrent disease. This multi-institutional study showed that each of the predictive tools studied could be used in Bulgarian patients with comparable accuracy. Compared with the JHH tables, the MSKCC prostate cancer nomograms showed higher predictive accuracy and should therefore be preferred.

[Laparoscopic excision of seminal vesicle cyst]

OBJECTIVE

To investigate the method and clinical efficacy of laparoscopic excision of seminal vesicle cyst.

METHODS

Laparoscopic excision of seminal vesicle cyst was performed under general anaesthesia in two patients with symptomatic seminal vesicle cyst confirmed by ultrasonography and CT scanning preoperatively. The sizes of the seminal vesicle cysts were 3.3 cm x 3.7 cm x 2.5 cm and 4.1 cm x 4.3 cm x 5.3 cm, respectively.

RESULTS

The operations were performed successfully in both the patients, with the operation time of 140 min and 100 min, blood loss of 50 ml and 20 ml, and postoperative stay of 6 days. The patients were followed up for 6 and 7 months, respectively. All the preoperative symptoms disappeared, and no complications and recurrence were found.

CONCLUSION

Laparoscopic excision of seminal vesicle cyst, with a good visual field, refined procedure, minimal invasiveness and rapid recovery, is a safe and effective surgical option for patients with seminal vesicle cyst.