Name: Application of Seminal Vesiculoscopy and Holmium Laser to Treat Ejaculatory Duct Blockage Caused by Cysts
Uploaded: 2023-12-08T14:00:00
Description: Watch this Scientific Journal Video about Application of Seminal Vesiculoscopy and Holmium Laser to Treat Ejaculatory Duct Blockage Caused by Cysts at JoVE.com

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

Seminal Vesiculoscope Laser-Assisted Surgery to Treat Ejaculatory Duct Blockage

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.

Author Spotlight: Advanced Treatment of Seminal Duct Blockage Employing Endoscopy-Mediated Semen Channel Refluviation 

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

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.

Watch this Scientific Journal Video about Application of Seminal Vesiculoscopy and Holmium Laser to Treat Ejaculatory Duct Blockage Caused by Cysts at JoVE.com

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

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.

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

Research

JoVE Journal

Medicine

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 ...