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Abstract
Purpose
To evaluate the usefulness and effectiveness of transurethral coagulation and incision of the ejaculatory duct for hematospermia caused by ejaculatory duct cyst and obstruction.
Materials and Methods
Twenty-six patients with hematospermia were enrolled. Ejaculatory duct cyst or obstruction was diagnosed by transrectal ultrasound or MRI, revealing seminal vesicle hypertrophy and cystic dilated ejaculatory ducts. One patient had hematospermia associated with infertility. The mean age of the patients and their duration of symptoms were 42.7 years (range, 25-67 years) and 16 months (range, 1-60 months), respectively. All patients underwent transurethral management for treatment of their ejaculatory duct obstruction in the form of incision and coagulation of the ejaculatory duct. We used a 9.5 Fr rigid ureteroscope (StortzⓇ, Germany) and a Bugbee electrode. Patients were followed for more than 3 months after the procedure.
Results
All patients reported improvement of hematospermia and disappearance of midline cysts, except for one patient. The one case, ureteroscope failed to pass through verumontanum. A ejaculatory duct cyst was found in 18 cases. Calculi were present in the seminal vesicle and ejaculatory ducts in 7 patients and were removed with endoscopic instruments. One infertile patient regained reproductive ability after the procedure. Postoperative complications, such as epididymitis, orchitis, or retrograde ejaculation were not observed.
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Fig. 1.
A 9.5 Fr rigid ureteroscope was inserted into the ejaculatory duct cyst via the utricular orifice at the verumontanum. (A) The prostate utricular orifice at the verumontanum. (B) The utricular lumen. (C) The ejaculatory duct cyst; stones and hemorrhage were identified and bilateral ejaculatory duct orifices were not identified. (D, E) Stones are removed by ureteroscopic foreign body forceps. (F) Right ejaculatory duct opening. (G) Ejaculatory duct cyst wall was electrocauterized and closed ejaculatory opening was opened (dark circle). (H) Left ejaculatory duct opening.
Fig. 2.
Preoperative (A, B) and postoperative (C, D) transrectal ultrasonographic (TRUS) findings. A round midline cyst (arrow) was disappeared after 3 months of operation. A and C; axial scan, B and D; sagittal scan.
Table 1.
Clinical features and result of transurethral coagulation and incision for hematospermia
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