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Volume 22, Issue 5 (September 2020) 22, 507–512; 10.4103/aja.aja_134_19

Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study

Xue-Sheng Wang1,2, Ming Li2, Guang-Feng Shao2, Wen-Dong Sun2, Xiu-Lin Zhang3, Zhi-Ying Xiao2,3, Zhen Ma2, Ming-Zhen Yuan4, Li-Qiang Guo4

1 Department of Urology, Center for Reproductive Medicine, Shandong University, Jinan 250001, China
2 Department of Urology, The Second Hospital of Shandong University, Jinan 250033, China
3 Institute of Urology, Shandong University, Jinan 250033, China
4 Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China

Correspondence: Dr. LQ Guo (glq_66@yeah.net) or Dr. MZ Yuan (yuanmingzhen2005@126.com)

Date of Submission 20-Mar-2019 Date of Acceptance 07-Oct-2019 Date of Web Publication 27-Dec-2019


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.

Keywords: persistent hematospermia; seminal vesiculoscopy; transrectal ultrasound

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