application of seminal vesiculoscopy and holmium laser to treat ejaculatory duct blockage caused by cysts

精囊镜激光辅助手术治疗射精管阻塞

Ejaculatory duct obstruction is a rare disease of the male reproductive system, with a reported incidence of 1%-5%1,2. Ejaculatory duct cysts represent the predominant cause of ejaculatory duct obstruction. Semen examination in typical EDO patients reveals four distinctive characteristics: 1. Semen volume less than 2 mL, with a direct correlation between obstruction severity and decreased volume; 2. Oligospermia, with bilateral complete obstruction resulting in azoospermia; 3. Decreased pH value of semen; 4. Reduced levels of seminal plasma fructose, sometimes even dropping to 0 mM/L3. Male infertility caused by EDO can be treated with surgery and is less effective with conservative treatment4. In the past, the main method was transurethral resection of the ejaculatory duct. Although this approach boasts benefits like reduced trauma and fewer intraoperative complications, the surgical removal of the verumontanum disrupts the normal physiological structure of the distal ejaculatory duct. This, in turn, increases the postoperative risk of complications such as urinary reflux, epididymitis, retrograde ejaculation, and urinary incontinence5. At the same time, heat production during the operation may lead to the injury of the ejaculatory duct, seminal vesicle, and even rectum, and the thermal effect of the electric incision may cause new obstruction6.
The verumontanum stands as a crucial anatomical element within the male reproductive system, ensuring the precise and regulated discharge of semen during ejaculation while also helping to prevent retrograde flow. Whether the disadvantages of TURED can be ameliorated by preserving the seminal caruncle is unclear. Several studies have attempted to utilize laser-assisted endoscopy for the treatment of EDO while preserving verumontanum2,7,8,9. Although the surgical approaches varied, post-operative semen recovery was notably successful with minimal complications. This indicates that preserving the epididymal head may be beneficial. However, the method they used is relatively complex and does not intervene in the healthy ejaculatory duct, which may increase the risk of recurrence. Therefore, we present a simple and effective surgical method.
In this study, the seminal vesiculoscope was guided into the ejaculatory duct cyst on the affected side by a wire guide. Then, the holmium laser was used to enlarge the ejaculatory duct opening on the affected side to ensure that it had a sufficiently large outflow channel.

作者聚焦： 采用内窥镜介导的精液通道再激流治疗精管阻塞的先进治疗 

精囊镜辅助血流调整治疗射精管梗阻

The scope of this study is mainly the clinical effect of seminal duct division assisted by vesiculoscope. In the treatment of seminal duct obstruction caused by seminal duct cysts. We clarify that this procedure employs seminal channel It's a very effective surgical method.The main challenge currently is that the incidence of ejaculatory duct obstruction caused by ejaculatory duct cysts is very low. And it is difficult to accumulate enough patients to conduct a large number of controlled studies with other surgical procedures. Compared with other surgical methods the method can preserve the distal anatomical structure of the seminal even better.And is less likely to cause complications of abnormal ejaculation. Abnormal lubrication. And the loss, has a lower increased risk rate of obstruction.In the future, we'll focus on improving the endoscopic technology. Even more slender and clear endoscopes for the diagnosis and the treatment of seminal disease.

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Application of Seminal Vesiculoscopy and Holmium Laser to Treat Ejaculatory Duct Blockage Caused by Cysts  

精囊镜检查和钬激光治疗囊肿引起的射精管阻塞的应用

首先，将患者置于截石术中以进行麻醉诱导。进行气管插管以支持呼吸。间歇性注射罗库溴铵以促进正性肌力松弛。用碘水对下腹部和会阴区域进行三次消毒。将精囊镜连接到显示系统，并通过尿道外开口插入内窥镜。然后小心地将其推进到后尿道。要确认准确位置，请观察光滑和微红色的尿道粘膜。注意精丘的可见度，并发现两侧射精管的两个小开口。将一根电线穿过患侧的开口引导至射精管囊肿，以到达充满浑浊液体的区域。用生理盐水冲洗囊肿后，寻找精管中的异常开口。然后通过异常的射精管囊肿口进入同侧精囊，露出多个蜂窝状的导管腔。使用 40 瓦的钬激光器，扩大射精管直径。为了保持抗尿液反流机制，沿尿流方向切开射精管开口。探索患侧异常射精管开口的对称位置以及健康侧的精囊。然后轻轻地将金属丝插入囊肿左下方和右侧的精囊中。最后使用钬激光，切开并扩大对侧人工开口。为防止血凝块堵塞，请插入一根 18 法式导管并用生理盐水连续冲洗。一个月后术后检查显示患侧射精管开放，verumontanum保存。内镜检查证实射精囊肿内存在导管外侧开口。术后第3个月，患者精液参数明显改善。

application-seminal-vesiculoscopy-holmium-laser-to-treat-ejaculatory

Research

JoVE Journal

Medicine

Application of Seminal Vesiculoscopy and Holmium Laser to Treat Ejaculatory Duct Blockage Caused by Cysts

107 次观看.  The Second Affiliated Hospital of Kunming Medical University. 首先，将患者置于截石术中以进行麻醉诱导。进行气管插管以支持呼吸。间歇性注射罗库溴铵以促进正性肌力松弛。用碘水对下腹部和会阴区域进行三次消毒。将精囊镜连接到显示系统，并通过尿道外开口插入内窥镜。然后小心地将其推进到后尿道。要确认准确位置，请观察光滑和微红色的尿道粘膜。注意精丘的可见度，并发现两侧射精管的两个小开口。将一根电...

视频: Application of Seminal Vesiculoscopy and Holmium Laser to Treat Ejaculatory Duct Blockage Caused by Cysts  

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

This protocol introduces the clinical application of seminal vesicle endoscopy combined with holmium laser in the treatment of ejaculatory duct obstruction caused by ejaculatory duct cyst.

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

科研

医学

To begin, position the patient in lithotomy for anesthesia induction. Perform tracheal intubation to support breathing. Inject rocuronium bromide intermittently for inotropic relaxation.Disinfect the lower abdomen and the perineal area three times with iodophor. Connect the seminal vesiculoscope to the display system and insert the endoscope through the external urethral opening. Then carefully advance it towards the posterior urethra.To confirm the accurate position, observe the smooth and reddish urethral mucosa. Note the visibility of the colliculus seminalis and spot the two small openings of the ejaculatory ducts on either side. Guide a wire to the ejaculatory duct cyst through the opening on the affected side to reach the area filled with cloudy fluid.After flushing the cyst with saline, look for abnormal opening in the seminal canal. Then enter the ipsilateral seminal vesicle through the abnormal ejaculatory duct cyst opening, revealing multiple honeycombed ductal lumens. Using a 40-watt holmium laser, expand the ejaculatory duct diameter.To preserve the anti-urine reflux mechanism, cut the ejaculatory duct opening along the direction of urine flow. Explore the symmetrical position of the abnormal ejaculatory duct opening on the affected side as well as the seminal vesicle of the healthy side. Then gently insert the wire into the seminal vesicle at the lower left and right of the cyst.Finally using the holmium laser, incise and widen the contralateral artificial opening. To prevent blood clots from blocking, indwell an 18-French catheter and rinse it continuously with physiological saline. Postoperative examination after a month showed the open ejaculatory duct on the affected side and the preserved verumontanum.Endoscopy confirmed the presence of lateral ductus openings within the ejaculatory cyst. The semen parameters of patients improved significantly in the third month after the surgery.