Objective: To compare three different pathways for transurethral seminal vesiculoscopy (SVS) and investigate the reliability and efficiency of transrectal ultrasonography (TRUS)-guided SVS (TRUS-SVS).
Methods: We retrospectively analyzed 90 cases of seminal vesiculoscopy conducted directly through the ejaculatory duct or prostatic utricle or under the guide of TRUS. We compared the success rate and complications among the three approaches.
Results: Operations were successfully performed in 87 (96.67%) of the 90 cases, 30 through the ejaculatory duct, 37 via the prostatic utricle, and 20 under the guide of TRUS, the operation time ranging from 25 to 75 minutes. Sperm was detected from the seminal vesicle fluid in (92.06%) of the azoospermia patients (58/63) during the surgery and in 77.78% of them (49/63) in semen analysis at 1 week postoperatively. Fifteen hematospermia and 12 spermatocystitis patients were cured. Postoperative follow-up found 20 cases of water-like semen and 3 cases of orchiepididymitis, but no such complications as retrograde ejaculation, incontinence, or rectourethral fistula.
Conclusions: Transejaculatory duct and transprostatic utricle pathways are two common approaches to SVS, while TRUS-SVS may achieve a higher success rate and avoid injury of both the prostate and the rectum.
目的: 总结实施精囊镜手术采用的3种不同进镜途径，探讨经直肠实时超声引导下精囊镜手术的可靠性和有效性。方法: 回顾性分析自2013年8月至2015年12月实施的精囊镜手术共90例，进镜途径为直接经射精管口、直接经前列腺小囊及经直肠实时超声引导下经前列腺小囊3种方式，进镜后对精囊疾病进行治疗，分别随访其治疗效果，比较3种进镜方式的成功率及并发症。结果： 90例患者手术时间为25~75 min，平均时间42.3 min,手术的总成功率为96.67%（87/90）。直接经射精管口（包括异位开口）途径进入精囊30例，６０例在正常解剖位置未找到射精管开口，采用经前列腺小囊途径进入精囊３７例，上述途径均失败后，采用经直肠实时超声引导下进入精囊20例，3例患者精囊镜手术失败。92.06%（58/63）无精子症患者术中精囊液查见精子，77.78%（49/63）术后1周精液常规见精子。15例血精及12例精囊炎患者术后随访均治愈。术后随访20例患者出现水样精液，睾丸附睾炎3例，无逆行射精、尿失禁及直肠损伤等并发症。结论： 经射精管口途径和经前列腺小囊途径为实施精囊镜手术的常规手术方法；而经直肠实时超声引导下经前列腺小囊途径能显著提高精囊镜检查成功率，避免术中对前列腺和直肠的损伤。.
Keywords: pathways of endoscopy; transrectal ultrasonography; opening of the ejaculatory duct; seminal vesiculoscopy.