Transurethral Exploration of Seminal Vesicle

Gao, P, Zhang, X

Transurethral Seminal Vesiculoscopy (TSV), Vesiculitis, Hematospermia

The patient is a 58-year-old male. Three years ago, he experienced frequent hematospermia accompanied by pain during ejaculation. Despite ineffective anti-inflammatory treatment, he underwent surgical treatment in our hospital, which was satisfactory. One month ago, the patient again presented with the aforementioned symptoms. After discussion within the department, a Transurethral Seminal Vesiculoscopy (TSV) was decided upon.^{[1, 2]}

After satisfactory anesthesia, the patient was placed in the lithotomy position. The F4.7 seminal vesicle endoscope was inserted through the external orifice of the urethra into the bladder. No obvious abnormalities were observed throughout the bladder and urethra. At about 3 o'clock near the neck of the small seminal vesicle, the left ejaculatory duct opening was found. ^[3]Under the guidance of the zebra guide wire, the left ejaculatory duct was entered until the left seminal vesicle was reached. Dark red bloody fluid and flocculent substances were observed in the left seminal vesicle, and the cyst wall showed chronic inflammatory changes. A stone was also found. The stone was removed using a stone basket, and then 1% gentamicin normal saline and levofloxacin solution were used for thorough rinsing.^[4] In the same manner, the right seminal vesicle was accessed using the guide wire. One stone was found in the right seminal vesicle. After the stone was removed, antibiotic solution was used for thorough rinsing. The seminal vesicle endoscope was then re-entered for observation. It was found that the stones had been removed from both seminal vesicles, and the fluid within the cysts was clear. The seminal vesicle endoscope was then withdrawn, and a urinary catheter was left in place. The patient was safely returned to the ward after the operation and was discharged smoothly.

None

The authors declare that the seminal vesiculoscopy equipment and consumables used in this case report were routinely purchased by the hospital, and the authors have no direct interests with the relevant manufacturers. No commercial organization or individual sponsored or intervened in this study. The content of this article is based on real clinical practice and there is no conflict of interest.

[1]    Yao R J, Xiao H, Chen S S, et al. Efficacy of various surgical approaches in treating hematospermia using  transurethral seminal vesiculoscopy[J]. BMC Surg, 2023,23(1):385.

[2]    Zaidi S, Gandhi J, Seyam O, et al. Etiology, Diagnosis, and Management of Seminal Vesicle Stones[J]. Curr Urol, 2019,12(3):113-120.

[3]    Andrade V, Pina J, Calais F, et al. Seminal Vesicle Calculi as a Cause of Hematospermia and Ejaculatory Pain: A Case  Report[J]. Cureus, 2023,15(7):e42547.

[4]    Drury R H, King B, Herzog B, et al. Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A  Narrative Review[J]. Sex Med Rev, 2022,10(4):669-680.