A Novel Surgical Management for Male Infertility Secondary to Midline Prostatic Cyst

Gong Cheng; Bianjiang Liu; Zhen Song; Aiming Xu; Ninghong Song; Zengjun Wang

Disclosures

BMC Urol. 2015;15(18) 

In This Article

Methods

Approval for this study was granted by the ethics committee of Nanjing Medical University (China) and informed written consent was received from all participants.

Patients

From February 2012 to December 2013, 12 patients were recruited at Department of Urology, The First Affiliated Hospital of Nanjing Medical University. The patients were aged 18–40 years. All of them complained of infertility 2–10 years after marriage. Two cases had hematospermia. Preoperative semen analyses of 12 patients showed oligoasthenozoospermia (5/12) or azoospermia (7/12), low semen volume (0–1.9 mL), and low pH level (5.5–7.0). Preoperative seminal plasma biochemical analyses showed reduced semen fructose. TURS (Figure 1A) and MRI (Figure 1B) revealed a cyst lesion located in the midline prostate.

Figure 1.

The representative images of MPC. A, TRUS; B, pelvic MRI. The arrow indicates the cystic lesion.

Procedures

The patients were placed under general anesthesia in the dorsal lithotomy position. Transurethral unroofing of MPC was performed using the F26 resectoscope. First, the resectoscope was inserted into prostatic urethra for preliminary visualization of the cyst (Figure 2A). Then the ridgy posterior wall of the urethra was resected for unroofing the MPC (Figure 2B and C). If the ejaculatory duct opening was not obvious, transurethral resection of the ejaculatory duct (TURED) was performed to make the ejaculatory duct unobstructed (Figure 2D). Lastly, the dilation of ejaculatory duct and the irrigation of seminal vesicle were performed using F7 seminal vesiculoscope according to our previous report.[3] Under the guidance of a zebra guidewire, the endoscope was inserted into the ejaculatory ducts and seminal vesicles at the help of hand-controlled intermittent water perfusion dilation. The seminal vesicles usually contained the congestive wall, and milky, yellow or pink vesicle fluid filled with flocculent turbidity and dark blood clots (Figure 3A). In some cases, seminal vesicle stones were even found (Figure 3B). The seminal vesicles were irrigated using a levofloxacin solution (Figure 3C and D). After operation, a urethral Foley catheter was remained overnight. All patients were required to refrain from ejaculation at least two weeks and followed up at least 3 months.

Figure 2.

Transurethral unroofing of MPC. A, the cyst is visualized through the resectoscope. B and C, the ridgy posterior wall of the urethra is resected for unroofing the MPC. D, TURED is performed to make the ejaculatory duct unobstructed.

Figure 3.

Transurethral irrigation of seminal vesicle. A, seminal vesiculitis contains the congestive wall, and milky, yellow or pink vesicle fluid filled with flocculent turbidity and dark blood clots. B, seminal vesicle stones. C and D, the seminal vesicle is washed clearly and irrigated using a levofloxacin solution.

Outcomes Analysis

Preoperative and postoperative serum sex hormone levels were recorded. Preoperative and postoperative semen qualities were monitored using a computer-assisted semen analyzer (IVOS; Hamilton-Thorne, Beverly, MA, U.S.).

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