Objective: To evaluate the effect of ejaculatory duct dilation combined with seminal vesicle clysis in the treatment of refractory hematospermia.
Methods: Using ureteroscopy, we treated 32 patients with refractory hematospermia by transurethral dilation of the ejaculatory duct combined with clysis of the seminal vesicle with diluent gentamicin.
Results: The operation was successfully accomplished in 31 cases, with the mean operation time of 32 (26－47) minutes. The patients were followed up for 6－39 (mean 23.6) months. No complications, such as urinary incontinence and retrograde ejaculation, were found after operation. Hematospermia completely disappeared in 27 cases, was relieved in 1, and recurred in 3 after 3 months postoperatively. Those with erectile dysfunction or mental anxiety symptoms showed significantly decreased scores of IIEF-Erectile Function (IIEF-EF) and Self-Rating Anxiety Scale (SAS).
Conclusions: Ejaculatory duct dilation combined with seminal vesicle clysis under the ureteroscope, with its the advantages of high effectiveness and safety, minimal invasiveness, few complications, and easy operation, deserves general clinical application in the treatment of refractory hematospermia.
目的： 探讨射精管扩张联合精囊冲洗治疗顽固性血精的临床价值。 方法： 采用经尿道输尿管镜技术，对32例顽固性血精患者直视下行经尿道扩张射精管、抗生素冲洗精囊治疗。结果： 32例顽固性血精患者均行射精管扩张，31例成功，平均手术时间32 min，中位随访23.6个月，术后无逆行射精、尿失禁等并发症。血精症状完全消失且无复发27例，1例患者术后血精症状无减轻，3例分别于术后3、5、8个月后复发。对伴有勃起功能障碍及精神焦虑症状的患者，术后平均IIEF-EF评分显著提高，SAS评分显著降低。结论： 应用经尿道输尿管镜技术行射精管扩张联合精囊冲洗治疗顽固性血精，安全性高、疗效好、创伤较小、并发症发生率低，操作简便，可以同时达到检查和治疗的目的，值得在临床推广应用。.
Keywords: ejaculatory duct; hematospermia; refractory; seminal vesicle; ureteroscopy.