Treatment of Infertility Caused By Incomplete Obstruction of The Seminal Tract Through Seminal Tract Reconstruction Via Seminal Vesiculoscopy

Jiang, T

Seminal vesiculoscopy, Infertility

The video introduced an innovative technique to seminal tract reconstruction via seminal vesiculoscopy. We applied this  approach to treat five cases of asthenozoospermia caused by incomplete obstruction of the seminal tract, utilizing MRI and real-time transrectal dynamic ultrasound monitoring of ejaculatory-orgasm (Rt-TRUS).

Surgical method: The patient is placed in the lithotomy position and general anesthesia is administered. The seminal vesicoscope is inserted under direct vision through the urethra. Upon locating the seminal orifice at the verumontanum, which is found to be closed, a hard tip guide wire is used to dilate and insert the seminal vesicoscope. The wall is observed to be very thin,  a significant protrusion of the cyst wall into the lumen was discovered by aspirating through the inflow pathway.

Since we cannot ascertain whether long-term compression and obstruction may lead to distal inflammation and fibrosis of the seminal ducts, nor can we guarantee that the seminal ducts will be smooth post-surgery. Therefore, we used  holmium laser to incise the cyst wall and the lateral wall of the seminal ducts that are adhered closely to the cyst simultaneously, thereby creating a new ejaculatory pathway from the seminal ducts through the verumontanum to the urethra.The reconstruction can bypasses fibrotic distal segments, allowing for direct semen drainage into the posterior urethra through newly established anatomical channels.

Postoperative data from 5 patients  showed significant improvements in semen parameters, including increased sperm concentration and enhanced progressive motility. During follow-up, three patients achieved natural pregnancy. This technique offers a minimally invasive and effective therapeutic option for obstructive infertility, marking an advancement in seminal tract reconstruction surgery.

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