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Title: [F4.8 visual miniature nephroscope for the diagnosis and treatment of hematospermia].
Author: Zhou KY, Yang WZ, Cui ZY, Wei RJ, Zhao CL, Ma T, An F.
Journal: Zhonghua Nan Ke Xue; 2018 Jun; 24(6):525-528. PubMed ID: 30173458.
Abstract:
OBJECTIVE: To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia. METHODS: This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation. RESULTS: Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication. CONCLUSIONS: The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability. 目的: 探讨F4.8可视微型肾镜在对血精的检查、治疗中的实用性及安全性。方法: 选取2015年6月至2016年11月顽固性血精患者12例，所有患者均伴有会阴部或下腹部疼痛不适，全身应用抗生素及局部理疗2个月无效。术前行经直肠精囊超声及精囊MRI或CT扫描等检查排除精囊肿瘤、结核等。硬膜外麻醉下F4.8可视微型肾镜逆行经尿道射精管口进入精囊后镜检：陈旧性血块予生理盐水冲洗；精囊结石予钬激光碎石、冲洗及网篮取石；精囊息肉予钬激光灼烧、汽化，标本送病理；术后稀释碘伏冲洗精囊腔后并保留。结果: 10例行双侧精囊镜检查： 3例单侧及2例双侧精囊结石者予钬激光碎石，生理盐水冲洗及网篮取石；2例精囊息肉成功予钬激光烧灼、汽化；3例陈旧性血块给予彻底冲洗。另2例行患侧精囊镜检（MRI示单侧精囊病变，对侧未能进入精囊腔）精囊腔内为陈旧性血块予彻底冲洗。手术时间10～55（25±6）min；术中、术后无直肠损伤、周围脏器损伤、外尿道括约肌损伤等并发症。术后留置尿管1 d，抗感染3 d，2周后规律性生活。随访6～20（7±2.3）个月，10例患者术后3个月血精及血精所致症状消失；2例患者术后4个月血精复发经敏感抗生素治疗后好转。结论: F4.8可视微型肾镜可用于精囊腔检查、精囊结石及精囊息肉的治疗，安全可靠。.

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