經尿道儲精囊內視鏡：血精的診斷與治療
胡如娟、陳卷書
臺中榮民總醫院泌尿外科
Transurethral Seminal Vesiculoscopy: A Diagnostic and Therapeutic Tool for Intractable Hemospermia
Ju-Chuan Hu、Chuan-Shu Chen
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Purpose:
Hemospermia is a fear-provoking symptom although it is usually benign and self-limiting. This study is aimed to review the anatomy of the seminal tract and provide a detailed description on the methodology of transurethral seminal vesiculoscopy (TUSV). The clinical experience based on a single surgeon was also reported.
Materials and Methods:
We used a 6/7.5 French semirigid ureteroscope which entered the seminal tract by one of the two approaches: through the opening of ejaculatory duct or transutrical fenestration. Patient characteristics and their preoperative and postoperative measurements were analyzed retrospectively.
Results:
Thirty-eight patients with intractable macroscopic hemospermia were enrolled consecutively from Jan 2010 to July 2016. The successful rate of TUSV was 92.1%. The transutrical fenestration method was the main approach of TUSV (88.9%). Seminal tract lithiasis was found in 44.4% cases and 94.4% patients reported complete remission of hemospermia. The median time to remission was 4 (Interquartile range, IQR 4-6) weeks. Although 11.76% patient reported recurrent hemospermia after median 21.5 (IQR 13-48.5) months, most of their hemospermia became less intractable and could be controlled by antibiotic only.
Conclusion:
Transurethral seminal vesiculoscopy is a valuable diagnostic tool for intractable hemospermia and might play a therapeutic role by blocking the vicious cycle between stasis, calculi and seminal vesiculitis.