This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜time transrectal ultrasonography(TRUS)in managing persistent...This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜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.展开更多
BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to...BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection,his subsequent management and outcome.CASE SUMMARY A 46-year-old man presented with recurrent episodes of painless hematospermia.This was not associated with any lower urinary tract symptoms.He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation,and underwent partial ileectomy and lymphadenectomy 4 years ago.Subsequent investigations included positronemission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle.Laparoscopic leftsided vesiculectomy was carried out.Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative,and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary.The patient had an uneventful post-operative recovery.He received adjuvant chemoradiotherapy following surgery.He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery.CONCLUSION Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.展开更多
Hematospermia is a rare condition, but often causes frustration. The reason for this frustration is that theexact incidence of hematospermia remains unknown and its cause is difficult to determine.^1 Many reports in t...Hematospermia is a rare condition, but often causes frustration. The reason for this frustration is that theexact incidence of hematospermia remains unknown and its cause is difficult to determine.^1 Many reports in the past decades have focused on the etiology of hematospermia.^2 Hematospermia is treated initially by administration of antibiotics, coagulants, and sex steroid hormones. However, some cases may prove resistant to this therapy and the condition may continue. For some intractable and agnogenic cases, the therapeutic strategy mentioned above is not very effective. Recently, we treated 63 such nonresponsive patients by direct continuous antibiotic irrigation into the bilateral seminal vesicles through puncture under transrectal ultrasonography （TRUS） guidance.展开更多
Background:Hematospermia,although often found to be a benign condition,can be an alarming sign.Consequently,patients undergo multiple investigations with no current standardized pathway based on data from large series...Background:Hematospermia,although often found to be a benign condition,can be an alarming sign.Consequently,patients undergo multiple investigations with no current standardized pathway based on data from large series.The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia.Materials and methods:A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center.Patient demographics,radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes.Results:In this cohort,the overall prostate cancer detection rate was 5.3%and 7.2%in the≥40 years group.One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy.In addition,5.6%of patients were found to have a significant benign pathology for which intervention was proposed.A total of 288 patients underwent a transrectal ultrasound scan and 58.7%(n=169)of these patients were found to have a positive finding.One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6%(n=81)had a positive finding.Conclusions:Apart from transrectal ultrasound and multiparametric magnetic resonance imaging,the remaining investigations have a low diagnostic yield.Prostate cancer detection was 5.3%;7.2%in the≥40 years group,and two further patients were diagnosed with testicular and bladder malignancy.Based on our results,we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.展开更多
基金the National Nature Science Foundation of China(Grant No.81670625)Shandong Province Natural Science Foundation-Doctoral Fund(No.ZR2017BH104)Shandong Province Natural Science Foundation-Surface Project(No.ZR2018MH006).
文摘This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy(TSV)guided by rea卜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.
文摘BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection,his subsequent management and outcome.CASE SUMMARY A 46-year-old man presented with recurrent episodes of painless hematospermia.This was not associated with any lower urinary tract symptoms.He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation,and underwent partial ileectomy and lymphadenectomy 4 years ago.Subsequent investigations included positronemission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle.Laparoscopic leftsided vesiculectomy was carried out.Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative,and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary.The patient had an uneventful post-operative recovery.He received adjuvant chemoradiotherapy following surgery.He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery.CONCLUSION Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.
文摘Objective To treat hematospermia by ureteroscopy and investigate its application value for treatment of hematospermia. Methods Nineteen patients with
文摘Hematospermia is a rare condition, but often causes frustration. The reason for this frustration is that theexact incidence of hematospermia remains unknown and its cause is difficult to determine.^1 Many reports in the past decades have focused on the etiology of hematospermia.^2 Hematospermia is treated initially by administration of antibiotics, coagulants, and sex steroid hormones. However, some cases may prove resistant to this therapy and the condition may continue. For some intractable and agnogenic cases, the therapeutic strategy mentioned above is not very effective. Recently, we treated 63 such nonresponsive patients by direct continuous antibiotic irrigation into the bilateral seminal vesicles through puncture under transrectal ultrasonography （TRUS） guidance.
文摘Background:Hematospermia,although often found to be a benign condition,can be an alarming sign.Consequently,patients undergo multiple investigations with no current standardized pathway based on data from large series.The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia.Materials and methods:A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center.Patient demographics,radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes.Results:In this cohort,the overall prostate cancer detection rate was 5.3%and 7.2%in the≥40 years group.One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy.In addition,5.6%of patients were found to have a significant benign pathology for which intervention was proposed.A total of 288 patients underwent a transrectal ultrasound scan and 58.7%(n=169)of these patients were found to have a positive finding.One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6%(n=81)had a positive finding.Conclusions:Apart from transrectal ultrasound and multiparametric magnetic resonance imaging,the remaining investigations have a low diagnostic yield.Prostate cancer detection was 5.3%;7.2%in the≥40 years group,and two further patients were diagnosed with testicular and bladder malignancy.Based on our results,we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.
