Korean J Urol.  2009 Mar;50(3):272-277.

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

• Kang PM
• Chung JI

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(R), 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.

Keyword

Hemospermia; Ejaculatory ducts; Endoscopy; Infertility

MeSH Terms

Calculi
Ejaculation
Ejaculatory Ducts
Electrodes
Endoscopy
Epididymitis
Hemospermia
Humans
Hypertrophy
Infertility
Male
Orchitis
Postoperative Complications
Seminal Vesicles
Ureteroscopes

Figure

• 

  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.

Reference

1.Leary FJ., Aguilo JJ. Clinical significance of hematospermia. Mayo Clin Proc. 1974. 49:815–7.

2.Papp G., Molnar J. Causes and differential diagnosis of hematospermia. Andrologia. 1981. 13:474–8.

3.Jones DJ. Haemospermia: a prospective study. Br J Urol. 1991. 67:88–90.

4.Byon SK., Rha KH., Yang SC. Transutricular seminal- vesicu-loscopy in the management of hematospermia. Korean J Urol. 2001. 42:329–33.

5.Cha SH., Hong SH., Seo SI., Kim JC., Hwang TK. Effectiveness of endoscopic management in recurrent hematospermia. Korean J Urol. 2005. 46:388–93.

6.Gerber GS., Brennder CB. Evaluation of the urologic patient: history, physical examination and urinalysis. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2007. 87.

7.Mulhall JP., Albertsen PC. Hemospermia: diagnosis and mana-gement. Urology. 1995. 46:463–7.

8.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.

9.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. 6:539–47.

10.Papp GK., Kopa Z., Szabo F., Erdei E. Aetiology of haemo-spermia. Andrologia. 2003. 35:317–20.

11.Kim JY., Park SS. The findings of transrectal ultrasonography in evaluation of organic hemospermia. Korean J Urol. 1993. 34:811–4.

12.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. 140:991–2.

13.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. 17:173–8.

14.Williams RD., Sandlow JI. Surgery of the seminal vesicles. Walsh PC, Retik AB, Vaugh ED, Wein AJ, editors. editors.Campbell's urology. 7th ed.Philadelphia: Saunders;1998. 3308-12.

15.Yang SC., Rha KH., Byon SK., Kim JH. Transutricular seminal vesiculoscopy. J Endourol. 2002. 16:343–5.

16.Fuse H., Nishio R., Murakami K., Okumura A. Transurethral incision for hematospermia caused by ejaculatory duct obstruction. Arch Androl. 2003. 49:433–8.

17.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. 22:719–24.

18.Fuse H., Mizuno I., Iwasaki M., Akashi T. Transurethral treatment of ejaculatory duct obstruction in infertile men. Arch Androl. 2003. 49:429–31.

19.Philip J., Manikandan R., Lamb GH., Desmond AD. Ejaculatory-duct calculus causing secondary obstruction and infertility. Fertil Steril. 2007. 88:706.