Platinum open access journal
pISSN 2466-0493 eISSN 2466-054X
Indexed in MEDLINE, SCIE, Scopus, DOAJ and more
    Korean J Urol. 2009 Mar;50(3):272-277. Korean.
    Published online Mar 25, 2009.
    https://doi.org/10.4111/kju.2009.50.3.272
    Copyright © The Korean Urological Association, 2009
    Original Article

    Effectiveness of Transurethral Coagulation and Incision of Ejaculatory Duct for Hematospermia Caused by Ejaculatory Duct Cyst and Obstruction

    Pil Moon Kang and Jae Il Chung
      • Department of Urology, Inje University, College of Medicine, Busan, Korea.
    • Correspondence to: Jae Il Chung. Department of Urology, Inje University Paik Hospital, 633-165, Gaegum-dong, Busanjin-gu, Busan 614-735, Korea. TEL: 051-890-6383, FAX: 051-892-9887, Email: prosdoc@hanmail.net
    Received January 09, 2009; Accepted February 06, 2009.

    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.

    Conclusions

    Transurethral incision and coagulation was a safe and effective treatment option for hematospermia caused by ejaculatory duct obstruction and is considered to be a successful treatment option for infertility secondary to ejaculatory duct obstruction.

    Keywords
    Hemospermia; Ejaculatory ducts; Endoscopy; Infertility

    Figures

    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.

    Tables

    Table 1
    Clinical features and result of transurethral coagulation and incision for hematospermia

    Notes

    This work was supported by the 2005 Inje University research grant.

    References

      1. Leary FJ, Aguilo JJ. Clinical significance of hematospermia. Mayo Clin Proc 1974;49:815–817.
      1. Papp G, Molnar J. Causes and differential diagnosis of hematospermia. Andrologia 1981;13:474–478.
      1. Jones DJ. Haemospermia: a prospective study. Br J Urol 1991;67:88–90.
      1. Byon SK, Rha KH, Yang SC. Transutricular seminal-vesiculoscopy in the management of hematospermia. Korean J Urol 2001;42:329–333.
      1. Cha SH, Hong SH, Seo SI, Kim JC, Hwang TK. Effectiveness of endoscopic management in recurrent hematospermia. Korean J Urol 2005;46:388–393.
      1. Gerber GS, Brennder CB. Evaluation of the urologic patient: history, physical examination and urinalysis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders; 2007. pp. 87.
      1. Mulhall JP, Albertsen PC. Hemospermia: diagnosis and management. Urology 1995;46:463–467.
      1. Munkel witz R, Krasnokutsky S, Lie J, Shah SM, Bayshtok J, Khan SA. Current perspectives on hematospermia: a review. J Androl 1997;18:6–14.
      1. Furuya S, Ogura H, Saitoh N, Tsukamoto T, Kumamoto Y, Tanaka Y. Hematospermia: an investigation of the bleeding site and underlying lesions. Int J Urol 1999;6:539–547.
      1. Papp GK, Kopa Z, Szabo F, Erdei E. Aetiology of haemospermia. Andrologia 2003;35:317–320.
      1. Kim JY, Park SS. The findings of transrectal ultrasonography in evaluation of organic hemospermia. Korean J Urol 1993;34:811–814.
      1. Fuse H, Sumiya H, Ishii H, Shimazaki J. Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography. J Urol 1988;140:991–992.
      1. Abe M, Watanabe H, Kojima M, Saitoh M, Ohe H. Puncture of the seminal vesicles guided by transrectal real-time linear scanner. J Clin Ultrasound 1989;17:173–178.
      1. Williams RD, Sandlow JI. Surgery of the seminal vesicles. In: Walsh PC, Retik AB, Vaugh ED, Wein AJ, editors. Campbell's urology. 7th ed. Philadelphia: Saunders; 1998. pp. 3308-3312.
      1. Yang SC, Rha KH, Byon SK, Kim JH. Transutricular seminal vesiculoscopy. J Endourol 2002;16:343–345.
      1. Fuse H, Nishio R, Murakami K, Okumura A. Transurethral incision for hematospermia caused by ejaculatory duct obstruction. Arch Androl 2003;49:433–438.
      1. Li L, Jiang C, Song C, Zhou Z, Song B, Li W. Transurethral endoscopy technique with a ureteroscope for diagnosis and mangement of seminal tracts disorders: a new approach. J Endourol 2008;22:719–724.
      1. Fuse H, Mizuno I, Iwasaki M, Akashi T. Transurethral treatment of ejaculatory duct obstruction in infertile men. Arch Androl 2003;49:429–431.
      1. Philip J, Manikandan R, Lamb GH, Desmond AD. Ejaculatoryduct calculus causing secondary obstruction and infertility. Fertil Steril 2007;88:706.
    Cited by
    Crossref 1
    Google Scholar 
    Scopus 1
    MeSH Terms
    Calculi
    Ejaculation
    Ejaculatory Ducts
    Electrodes
    Endoscopy
    Epididymitis
    Hemospermia
    Humans
    Hypertrophy
    Infertility
    Male
    Orchitis
    Postoperative Complications
    Seminal Vesicles
    Ureteroscopes
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide

    1 / 1

    PERMALINK