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Gupta V, Khan RK, Kumar LP. Zinner syndrome: A mesonephric duct anomaly with renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Drury RH, King B, Herzog B, Hellstrom WJG. Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A Narrative Review. Sex Med Rev 2021; 10:669-680. [PMID: 37051970 DOI: 10.1016/j.sxmr.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare condition that is historically idiopathic or associated with sexual behavior. Technological advances have identified many of the etiologies behind HS, improving treatment. Though often benign, HS remains a source of considerable sexual anxiety for patients. Few papers have outlined a diagnostic and therapeutic approach to HS, and none have explicitly addressed its sexual consequences. OBJECTIVES To provide a comprehensive overview of HS, emphasizing its sexual ramifications. METHODS A PubMed literature search was performed through May 2021 to identify all relevant publications related to etiology, diagnosis, treatment, and sexual effects of HS. Original research and reviews were analyzed, and pertinent studies were included in this review. RESULTS Iatrogenic interventions (eg, transrectal ultrasound-guided prostate biopsies) are the most common cause of HS. Infection and/or nonspecific inflammation is the most common non-iatrogenic etiology. Malignancies, including prostate, testicular, and other genitourinary cancers, are rarely the cause of HS. Diagnostic approaches to HS can be organized according to patient age (less than or greater than 40 years old), persistence of bleeding, and the presence/absence of concerning symptoms. Though HS often spontaneously resolves, treatment may require various medications (eg, antibiotics, anti-inflammatories) or surgical interventions. HS has several sexual ramifications, including libido-affecting anxiety, social repercussions from sexual partners and non-sexual affiliates, increased risk of erectile dysfunction or transmission of sexual infections, and compromised fertility, especially when cryopreservation is utilized. CONCLUSION HS may significantly affect sexual health through several mechanisms, though there is a paucity of formal data on this subject. Further research is needed to fully understand the severity and extent of HS's effect on sexual well-being, especially in those with refractory bleeding. Drury RH, King B, Herzog B, et al. Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A Narrative Review. Sex Med Rev. 2021;XX:XXX-XXX.
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Affiliation(s)
- Robert H Drury
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Brendan King
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Bryan Herzog
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
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Cui B, Wu JT, Xu JJ, Ou TW. Efficacy and feasibility of day surgery using transurethral seminal vesiculoscopy under caudal block anesthesia for intractable hemospermia. Transl Androl Urol 2020; 9:2493-2499. [PMID: 33457223 PMCID: PMC7807306 DOI: 10.21037/tau-20-870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Transurethral seminal vesiculoscopy (TSV) is a safe and effective method for intractable hemospermia. It uses a natural cavity, is fast, involves little trauma, and boasts a low incidence of complications. Because uncontrollable penile erection during general anesthesia will severely influence the surgical operation or even damage the endoscope, spinal anesthesia was applied more on TSV. But spinal anesthesia extends the length of stay in the hospital and brings patients unnecessary discomfort. As the TSV is a quick recovery operation, we should think about a more suitable mode for these patients. Methods A total of 141 patients received TSV between January 2015 and July 2019: 81 patients received day surgery under caudal block (group A), and 60 received inpatient surgery under spinal anesthesia (group B). Operative time, postoperative hospital stay, hemospermia remission rate, magnetic resonance imaging (MRI) remission rate are compared. Visual analog scale (VAS) scores of groups were taken and compared at 2 time points: when there was pain during surgery (T1) and at the end of surgery (T2). Surgical methods of two groups are the same. Results The mean operative time of two groups are 34 min (group A) and 32 min (group B), and there was no statistical difference. Postoperative hemospermia remission rates are both 100% at 3 months, which at 6 months are 60% and 48%, and there was no statistical difference. MRI remission at 3 months are 72% and 57%, which has no statistical difference. Postoperative complications were mild in two groups like hematuria and dysuria which can relieve within one day, and there were no severe complications. Intraoperative pain was present in 18.5% (15/81) of group A. Their highest VAS score was 3 points, indicating mild pain, which did not influence the surgical process or postoperative recovery. The postoperative VAS scores were similar between the 2 groups. Group A did not require postoperative hospitalization, whereas the average postoperative hospitalization in group B was 2 days. Conclusions Seminal vesiculoscopy can be performed as a day surgery under caudal block, which has obvious advantages in accelerating postoperative recovery and shortening the hospital stay.
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Affiliation(s)
- Bo Cui
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiang-Tao Wu
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian-Jun Xu
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tong-Wen Ou
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Khodamoradi K, Kuchakulla M, Narasimman M, Khosravizadeh Z, Ali A, Brackett N, Ibrahim E, Ramasamy R. Laboratory and clinical management of leukocytospermia and hematospermia: a review. Ther Adv Reprod Health 2020; 14:2633494120922511. [PMID: 32577619 PMCID: PMC7290265 DOI: 10.1177/2633494120922511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
Leukocytospermia and hematospermia are defined as the presence of abnormally high white blood cell and red blood cell concentration in the semen, respectively. Numerous etiologies and various implications on fertility have been identified. In a small proportion of men, the presence of white blood cells or red blood cells can adversely affect sperm quality by the production of reactive oxygen species. Several methods have been used to assess the presence of white blood cells and red blood cells in samples, such as identification of round cells, immunohistochemical staining using monoclonal antibodies, the Endtz test, the peroxidase test, and flow cytometry or microscopy. In addition, techniques have been identified to separate sperm samples from white blood cells and red blood cells for cryopreservation to improve outcomes in assisted reproductive technology. In this review, laboratory and clinical management of leukocytospermia and hematospermia are discussed. Currently available diagnostic methods and treatment options are outlined, and available optimal cryopreservation techniques for samples with white blood cells or red blood cells are summarized.
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Affiliation(s)
- Kajal Khodamoradi
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Manish Kuchakulla
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Manish Narasimman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Zahra Khosravizadeh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aleena Ali
- Des Moines University, Des Moines, IA, USA
| | - Nancy Brackett
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Emad Ibrahim
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1563, Miami, FL 33136, USA
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Li ZY, Xu Y, Liu C, Xiao ZM, Luo BH, Xu GW, Wu KC, Zhong SZ, Ouyang J. Anatomical study of the seminal vesicle system for transurethral seminal vesiculoscopy. Clin Anat 2018; 32:244-252. [PMID: 30281853 DOI: 10.1002/ca.23293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/07/2018] [Accepted: 09/28/2018] [Indexed: 01/23/2023]
Abstract
Because of a general lack of knowledge regarding the precise anatomy of the seminal vesicle system, efforts to use transurethral seminal vesiculoscopy (TSV) are currently constrained. We investigated 26 normal adult male specimens. Contrast medium was injected into the seminal vesicle system in 18 specimens and the openings of the ejaculatory ducts were examined with an operating microscope. India ink was injected into the urethra in four specimens to investigate the function of the ejaculatory duct valve. Another four specimens were examined histologically to identify the anatomical relationships of the seminal vesicle system. We found that the openings of the ejaculatory ducts were covered by the ejaculatory duct valve, which could be classified into two types and acted as a one-way valve. The apex of the seminal colliculus together with the right and left openings of the ejaculatory ducts formed a shape resembling an isosceles triangle. This could be used to locate the openings of the ejaculatory ducts during TSV. The ejaculatory ducts can be classified into two types according to their course. During surgery, efforts must be made to protect the ejaculatory duct valve. During inspection or surgery, the second segment and the angles of the ejaculatory ducts, particularly in Type Ib and Type II cases, require particular attention. Clin. Anat. 32:244-252, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Ze Y Li
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Yu Xu
- Department of Orthopedic Surgery, Nan fang Hospital, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Zhao M Xiao
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Bao H Luo
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Guang W Xu
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Kun C Wu
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Shi Z Zhong
- Department of Anatomy, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- Department of Anatomy, Southern Medical University, Guangzhou, China
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Zhang W, Xiao G, Qin S, Reed-Maldonado AB, Xu J, Chen G, Wang L, Zhou T. An Innovative Technique of Transurethral Seminal Vesiculoscopy with Ultrasonic Lithotripter for Severe, Persistent Hematospermia. J Endourol 2017; 31:1277-1282. [PMID: 29048208 DOI: 10.1089/end.2017.0390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Transurethral seminal vesiculoscopy (TSV) provides an efficient approach to diagnose and treat hematospermia, but still needs further improvement in manipulation and corresponding instruments. In this study, we develop an innovative technique with ultrasonic lithotripter (EMS) to treat severe, persistent hematospermia. PATIENTS AND METHODS Data of patients who underwent TSV with or without ultrasonic lithotripter between May 2012 and December 2015 was reviewed. For the innovative procedure, a 3.3F ultrasonic lithotripter was introduced through the working channel of an 8F seminal vesiculoscope to remove calculi, blood clots, or purulent material, whereas in routine procedure, the holmium laser lithotripsy was performed with lower energy (maximum power 10 W). Complication, hematospermia recurrence, the operative time, and postoperative hospitalization were recorded. RESULTS A total of 30 patients, 16 in Group A (routine TSV) and 14 in Group B (TSV with ultrasonic lithotripter procedure), were involved in this study. The median follow-up time for patients in Group A and B was 28 and 31 months, respectively. The mean operative time in Group A and B was 66 and 50 minutes, respectively (p < 0.05). All the TSV procedures in Group B were successful, except one patient had a two-stage procedure because of right seminal vesicle stones accompanying with pus. One patient in Group A had the discontinuation of the procedure because of accidental bleeding during stone fragmentation. During the follow-up, two patients in Group A had recurrent hematospermia and underwent the second TSV, whereas no recurrence happened in Group B. No epididymitis, retrograde ejaculation, rectal injury, incontinence, bladder neck contracture, or erectile dysfunction happened in both groups. CONCLUSION TSV with ultrasonic lithotripter enables a more reliable, effective, and convenient procedure to diagnose and treat severe, persistent hematospermia. It controls the recurrent hematospermia with less operative time and complication.
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Affiliation(s)
- Wei Zhang
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Guang'an Xiao
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Shengfei Qin
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
| | | | - Jian Xu
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Guanghua Chen
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Lei Wang
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Tie Zhou
- 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China
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Suh Y, Gandhi J, Joshi G, Lee MY, Weissbart SJ, Smith NL, Joshi G, Khan SA. Etiologic classification, evaluation, and management of hematospermia. Transl Androl Urol 2017; 6:959-972. [PMID: 29184797 PMCID: PMC5673809 DOI: 10.21037/tau.2017.06.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hematospermia is defined by the presence of blood in the semen typically occurring in men younger than 40 years of age. Symptoms can occur due to a multitude of reasons, but are usually benign and self-limiting, requiring no additional treatment or evaluation. Despite this, the condition often impairs quality of life due to associated anxiety and must be taken seriously by the patient and the physician, particularly if recurrent, refractory, and painful. The etiology of hematospermia can be classified into inflammatory, infectious, lithiasis, cystic, obstructive, tumoral, vascular, traumatic, iatrogenic, and systemic origin. Alternatively, it can also be divided into subcategories based on anatomical origins such as prostate, bladder, spermatic cord, seminal vesicles, or epididymis. A complete history and physician examination, laboratory testing, and a variety of invasive and non-invasive imaging and instrumentation modalities can help to identify and treat the underlying pathology promptly.
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Affiliation(s)
- Yiji Suh
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Medicine at Southampton Hospital, Southampton, NY, USA
| | - Min Yea Lee
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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