Transurethral ablation of a prostatic utricle cyst with the use of a holmium laser.

OBJECTIVE: To demonstrate a safe and effective approach to the treatment of obstructing midline prostate utricle cyst with the use of a holmium laser. DESIGN: Video presentation. SETTING: University hospital. PATIENT(S): A 33-year-old man presented with chronic pelvic pain, pain with ejaculation, and infertility. Semen analysis demonstrated oligoasthenospermia with poor viability and computerized tomographic scan identified the presence of a midline 2-3-cm prostatic cyst with dilated seminal vesicles bilaterally. Transrectal ultrasound in the office confirmed the diagnosis of midline obstructing prostatic utricle cyst and estimated the distance from the urethra. INTERVENTION(S): Transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. MAIN OUTCOME MEASURE(S): Intraoperative technique highlighting the main steps for a transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. RESULT(S): This video highlights the technique for transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser to unroof the cyst. Retrograde vesiculography was performed to confirm patency of the ejaculatory ducts. Outpatient surgery was tolerated well and the patient was discharged. After surgery at 4 weeks, his symptoms had abated and semen analysis revealed normozoospermia. CONCLUSION(S): We demonstrate safe and effective transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. Preoperative transrectal ultrasound or cross-sectional imaging can be useful for operative planning. When the orifices of the ejaculatory ducts can be identified, vesiculography can be performed to confirm patency of the ducts and seminal vesicles after relief of the obstructing cyst.

[Qilin Pills for obstructive azoospermia after ejaculatory duct reconstruction].

OBJECTIVE: To observe the clinical effect of Qilin Pills in the treatment of severe oligozoospermia after microsurgical ejaculatory duct reconstruction for obstructive azoospermia. METHODS: We retrospectively analyzed 75 cases of obstructive azoospermia treated by ejaculatory duct reconstruction followed by administration of Qilin Pills. The patients were divided into a Qilin group (n=42) and a control group (n=33) postoperatively, treated with Qilin Pills and placebo, respectively. After 3 months of medication, we compared the sperm quality between the two groups of patients. RESULTS: After 3 months' treatment, all the patients experienced remarkable improvement in sperm quality (P<0.05). Compared with the controls, the patients in the Qilin group showed dramatic increases in sperm concentration, from (0.57±0.25) and (0.60±0.18) ×106/ml before medication to (2.83±0.59) and (1.72 ±0.52) ×106/ml after medication, significantly higher in the Qilin than in the control group (P<0.05). The percentage of grade a sperm was increased from (5.52±5.97) and (5.30±6.26)% to (11.56±9.96) and (10.27±6.52)%, that of grade a+b sperm from (9.68±8.63) and (8.64±10.10)% to (23.42 ±14.10) and (20.81±14.70)%, and that of morphologically normal sperm from (2.00±1.27) and (2.31±0.94)% to (3.54±2.47) and (3.47±1.33)%, respectively. No statistically significant differences were observed in sperm motility and normal sperm morphology between the two groups after treatment (P>0.05). The total effectiveness rate was higher in the Qilin group than in the controls (88.1% vs 72.7%), but with no significant difference between the two groups (P>0.05). CONCLUSIONS: Qilin Pills are fairly effective in improving the quantity of sperm in obstructive azoospermia patients after ejaculatory duct reconstruction.

Qilin Pills for obstructive azoospermia after ejaculatory duct reconstruction / 中华男科学杂志

<p><b>Objective</b>To observe the clinical effect of Qilin Pills in the treatment of severe oligozoospermia after microsurgical ejaculatory duct reconstruction for obstructive azoospermia.</p><p><b>METHODS</b>We retrospectively analyzed 75 cases of obstructive azoospermia treated by ejaculatory duct reconstruction followed by administration of Qilin Pills. The patients were divided into a Qilin group (n=42) and a control group (n=33) postoperatively, treated with Qilin Pills and placebo, respectively. After 3 months of medication, we compared the sperm quality between the two groups of patients.</p><p><b>RESULTS</b>After 3 months' treatment, all the patients experienced remarkable improvement in sperm quality (P<0.05). Compared with the controls, the patients in the Qilin group showed dramatic increases in sperm concentration, from (0.57±0.25) and (0.60±0.18) ×10⁶/ml before medication to (2.83±0.59) and (1.72 ±0.52) ×10⁶/ml after medication, significantly higher in the Qilin than in the control group (P<0.05). The percentage of grade a sperm was increased from (5.52±5.97) and (5.30±6.26)% to (11.56±9.96) and (10.27±6.52)%, that of grade a+b sperm from (9.68±8.63) and (8.64±10.10)% to (23.42 ±14.10) and (20.81±14.70)%, and that of morphologically normal sperm from (2.00±1.27) and (2.31±0.94)% to (3.54±2.47) and (3.47±1.33)%, respectively. No statistically significant differences were observed in sperm motility and normal sperm morphology between the two groups after treatment (P>0.05). The total effectiveness rate was higher in the Qilin group than in the controls (88.1% vs 72.7%), but with no significant difference between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>Qilin Pills are fairly effective in improving the quantity of sperm in obstructive azoospermia patients after ejaculatory duct reconstruction.</p>

New myotropic and metabotropic actions of pyrokinins in tenebrionid beetles.

Pyrokinins are a large family of insect neuropeptides exhibiting pleiotropic activity, but are predominantly myostimulatory hormones. In this study, four pyrokinins Tenmo-PK-1 (HVVNFTPRLa), Tenmo-PK-2 (SPPFAPRLa), Tenmo-PK-3 (HLSPFSPRLa) and Zopat-PK-1 (LPHYPRLa) from the neuro-endocrine system of two tenebrionid beetles, Tenebrio molitor and Zophobas atratus, were tested in homologous bioassays to evaluate their putative myotropic and glycaemic actions. The four investigated bioassays systems (the heart, oviduct, ejaculatory duct and hindgut) revealed species-specific and organ-specific myotropic actions for the pyrokinins tested. In most bioassays with both beetles, the peptides showed myostimulatory properties with different efficacy. However, the T. molitor heart is not sensitive to Tenmo-PK-1, Tenmo-PK-2 and Tenmo-PK-3, and one of the peptides Tenmo-PK-1, is myoinhibitory on the oviduct. Tenmo-PK-2, which is also present in Z. atratus, exerted an inhibitory effect on the contractions of the heart and ejaculatory duct muscles in this beetle. Such myoinhibitory properties of pyrokinins in insects are shown here for the first time. Only one of the peptides tested, Tenmo-PK-2, stimulated a hyperglycaemic response in the haemolymph of larvae of T. molitor and Z. atratus, and this effect suggests a possible additional metabotropic function of this peptide in beetles. The differences in the myotropic and glycaemic responses to pyrokinins suggest that these peptides modulate contractions of muscles from visceral organs and free sugar levels in the haemolymph of the beetles, through complex and species-specific mechanisms.

[Partial ejaculatory duct obstruction induces hemospermia syndrome in the rat model].

OBJECTIVE: To investigate the pathogenesis of hematospermia syndrome using the rat model of hemospermia induced by partial ejaculatory duct obstruction. METHODS: Fifty male rats were divided into Groups A (n=20) and B (n=30), the former subjected to incomplete ligation of the right ejaculatory duct, while the latter open-close sham operation. Electro-stimulation was performed for ejaculation induction one week after the operation. Those that developed hematospermia in Group A were chosen as Group A1, while those with normal ejaculation in Group B included in Group B1. The semen indexes and seminal vesicle pressure were compared between Groups A1 and B1. RESULTS: Compared with Group B1, Group A1 showed significantly decreased semen volume (P < 0.01), lower sperm motility (P < 0.01) and higher seminal vesicle pressure (P < 0.01), but no statistically significant differences were observed in the WBC count and sperm density in the semen between the two groups (P > 0.05). CONCLUSION: Hemospermia syndrome can be induced by partial ejaculatory duct obstruction, with changes of semen indexes, and it is closely correlated with high seminal vesicle pressure.

Partial ejaculatory duct obstruction induces hemospermia syndrome in the rat model / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the pathogenesis of hematospermia syndrome using the rat model of hemospermia induced by partial ejaculatory duct obstruction.</p><p><b>METHODS</b>Fifty male rats were divided into Groups A (n=20) and B (n=30), the former subjected to incomplete ligation of the right ejaculatory duct, while the latter open-close sham operation. Electro-stimulation was performed for ejaculation induction one week after the operation. Those that developed hematospermia in Group A were chosen as Group A1, while those with normal ejaculation in Group B included in Group B1. The semen indexes and seminal vesicle pressure were compared between Groups A1 and B1.</p><p><b>RESULTS</b>Compared with Group B1, Group A1 showed significantly decreased semen volume (P < 0.01), lower sperm motility (P < 0.01) and higher seminal vesicle pressure (P < 0.01), but no statistically significant differences were observed in the WBC count and sperm density in the semen between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Hemospermia syndrome can be induced by partial ejaculatory duct obstruction, with changes of semen indexes, and it is closely correlated with high seminal vesicle pressure.</p>

Ejaculatory duct obstruction after transurethral resection of the prostate.

Transurethral resection of the prostate is currently the most commonly employed surgical procedure for benign prostatic hyperplasia. Although several complications after the procedure have been well documented, ejaculatory duct obstruction is a rare complication. We describe this unusual complication in a 77-year-old male who presented with severe pain and a feeling of fullness in the lower abdomen and with dry ejaculate on three occasions after undergoing post-transurethral resection of the prostate. The patient's post-ejaculatory urinalysis demonstrated no sperm. Transrectal ultrasonography also showed no dilatation of the bilateral seminal vesicles or ejaculatory ducts. However, ejaculatory duct obstruction was finally diagnosed on vasovesiculography. The patient was successfully treated with transurethral resection of the ejaculatory duct and remained asymptomatic 6 months postoperatively. Although transrectal ultrasonography is currently widely used to evaluate ejaculatory duct obstruction, we suggest that vasovesiculography is still a feasible and useful tool that provides detailed anatomic information for the advanced confirmation of ejaculatory duct obstruction in patients with a high suspicion of ejaculatory duct obstruction who have normal transrectal ultrasonography findings.

[Ejaculatory duct obstruction]. / Obstrucción de conductos eyaculadores.

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

Obstrucción de conductos eyaculadores / Ejaculatory duct obstruction

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

[Diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia (report of 3 cases)].

OBJECTIVE: To investigate the characteristics of diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia. METHODS: Retrospective analyses were made of the clinical data of 3 cases of ejaculatory duct obstruction following prostatic hyperthermia. RESULTS: The 3 cases were diagnosed as urethrostenosis and deformity of the posterior urethra by transurethral ultrasound and semen analysis. And all the 3 patients had undergone prostatic hyperthermia for prostatitis. Transurethral resection of the ejaculatory duct (TURED) was performed to remove the obstruction and the postoperative semen analysis showed both semen volume and sperm count to be normal. CONCLUSION: Urethra microwave thermotherapy, urethra radiofrequency, or per urethra rheophore ablation can be adopted in the treatment of protatitis, but should be strictly indicated and cautiously selected lest secondary iatrogenic ejaculatory duct obstruction should result. For the treatment of this obstruction, TURED is the first choice.

Diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia (report of 3 cases) / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia.</p><p><b>METHODS</b>Retrospective analyses were made of the clinical data of 3 cases of ejaculatory duct obstruction following prostatic hyperthermia.</p><p><b>RESULTS</b>The 3 cases were diagnosed as urethrostenosis and deformity of the posterior urethra by transurethral ultrasound and semen analysis. And all the 3 patients had undergone prostatic hyperthermia for prostatitis. Transurethral resection of the ejaculatory duct (TURED) was performed to remove the obstruction and the postoperative semen analysis showed both semen volume and sperm count to be normal.</p><p><b>CONCLUSION</b>Urethra microwave thermotherapy, urethra radiofrequency, or per urethra rheophore ablation can be adopted in the treatment of protatitis, but should be strictly indicated and cautiously selected lest secondary iatrogenic ejaculatory duct obstruction should result. For the treatment of this obstruction, TURED is the first choice.</p>

Mechanism and Type of Dry Ejaculation after Transurethral Microwave Thermotherapy / 대한남성과학회지

PURPOSE: To investigate the mechanism and type of aspermic ejaculatory dysfunction resulting from high-energy transurethral microwave thermotherapy of benign prostatic hyperplasia. MATERIALS AND METHODS: Eleven patients who complained of dry ejaculation longer than 12 months after transurethral microwave thermotherapy were examined. Transrectal ultrasonography as used to assess seminal vesicle or ejaculatory duct dilatation, urethroscopy to identify any ejaculatory duct orifice obstruction, and urinalysis after ejaculation to detect sperm as an indicator of retrograde ejaculation. RESULTS: Four of eight patients with no sperm on urinalysis after ejaculation showed both seminal vesicle dilation and ejaculatory duct orifice obstruction with or without verumontanal scar formation. Another three patients showed either seminal vesicle dilation or ejaculatory duct orifice obstruction, and the final patient with no sperm on urinalysis showed neither seminal vesicle dilation nor ejaculatory duct orifice obstruction. Five patients with no sperm on urinalysis after ejaculation complained of some combination of perineal, scrotal, and urethral discomfort during or immediately after ejaculation. Three patients had sperm in their urine after ejaculation. CONCLUSIONS: In 7 patients (63.6%), dry ejaculation resulted from ejaculatory duct obstruction. Three patients (27.3%) had retrograde ejaculation, and one patient (0.09%) may have had dry ejaculation as a result of failure of spermatogenesis. The main mechanism of dry ejaculation after transurethral microwave thermotherapy seems to be ejaculatory duct obstruction, not failure of bladder neck closure.

Changes in prostatic thickness and the location of ejaculatory ducts in autopsy prostates.

OBJECTIVE: To measure prostatic thickness and the depth of ejaculatory ducts from the urethral surface to prevent ejaculatory duct damage during transurethral balloon laser thermotherapy. MATERIALS AND METHODS: In 47 prostates obtained at autopsy, the prostatic thickness and the depth of ejaculatory ducts from the urethral surface were measured in eight directions from the centre of the urethra. RESULTS: The depth of ejaculatory ducts was approximately 6 mm from the urethral surface regardless of prostatic weight. Increase in prostatic weight was associated with increase in the thickness in all directions except the posterior one; the thickness ranged from 9 to 20 mm. The posterior thickness at the level of the transition zone was 10 mm regardless of prostatic weight. CONCLUSION: When benign prostatic hypertrophy is treated transurethrally, using laser or microwave equipment, care should be taken to avoid heating the posterior region of the prostate.

No incision percutaneous seminal vesiculography / 대한비뇨기과학회지

Seminal vesiculography is an excellent method of evaluating the male genital tract not only for obstruction but also for other structural lesions that may cause infertility. To date it has been usually performed under general or spinal anesthesia as a preliminary to an operative procedure or durirre the epididymovasastomy. We report on no incision percutaneous seminal vesiculography under local anesthesia prior to the surgical correction of infertility. It was developed by applying the percutaneous vas puncture technique to seminal vesiculography and needed neither incision nor dissection. Thirty azoospermic patients were evaluated by this method for patency and image of the vas, seminal vesicles and ejaculatory ducts before corrective surgery. Not more than three punctures were made on one vas. To clarify the possibility that it may be complicated by the stenosis of the vas at the puncture site, fifteen patients were evaluated by intraoperative seminal vesiculography two months later and among them three patients were additionally evaluated pathologically. In cases whose vases were punctured more than twice at the same site of the vas, there were partial or severe obstruction but there was no obstruction when multiple punctures were done on the different sites of one vas. Although this procedure requires a fair skill. it is simple to an expert. We could suggest that no incision percutaneous seminal vesiculography is plausible, safe and valuable in saving unnecessary scrotal exploration and shortening the surgical time. The future roles of this imaging technique are discussed.

Treatment of anejaculation with electroejaculation.

Male infertility caused by anejaculation is common after spinal cord injury (SCI) and following retroperitoneal lymph node dissection (RPLND) for testicular cancer. Other conditions sometimes associated with neurogenic ejaculation loss are diabetes mellitus, multiple sclerosis, extensive pelvic surgery and adult myelodysplasia. Primary absence of ejaculation also has been described. Few treatment options exist for these patients, if they wish to father a child. With electroejaculation (EEJ), or the low-current stimulation of the ejaculatory organs via a rectal probe, emission of semen can be initiated in these men. In non-SCI-patients EEJ requires general anaesthesia. The collected semen is washed and the motile sperm fraction isolated before artificial insemination (AI) of the partner. At the University of Michigan 198 men have been treated between 1986 and December 1991. An ejaculate could be obtained from nearly all patients. A major obstacle to success is the severe asthenozoospermia and the poor functional quality of the obtained sperm samples. This can be caused by the EEJ-technique itself, as well as by the long anejaculatory status. A semen sample with at least 10 million progressively motile sperm cells, useful for AI, was obtained in 75% of the SCI men and in 87% of the men following RPLND. In the couples wishing insemination, 49 pregnancies were induced, accounting for an overall pregnancy rate of 35% per couple. Thirty five healthy babies have been born. Only three complications were encountered. At Hannover Medical School only few patients have been stimulated to date. We could obtain an adequate sperm sample for AI from all of them. No complications were seen. As the first couple has just entered the phase of AI with husband sperm, an analysis of these results would be premature. Electroejaculation combined with artificial insemination is an efficient and safe treatment of male infertility due to neurogenic anejaculation.

A Study on Preservation of Normal Ejaculatory Function After Transurethral Resection in Benign Prostatic Hypertrophy / 대한비뇨기과학회지

It is well known fact that dry ejaculation is commonly found following simple prostatectomy including transurethral resection of hypertrophied prostate. To preserve normal ejaculatory function following transurethral resection in benign prostatic hypertrophy patients, we have modified the technique of transurethral resection to give less injury to the bladder neck, ejaculatory duct, urethral mucosa and branches of nerves by preserving smaller lateral lobe in cases one lateral lobe is much smaller than the other, or preserving lower one third of a lateral lobe in cases of big bilateral lobes, resecting all other lobes(B-type), and this technique was applied in 66 cases. Control group was 24 cases in which all lobes were resected like ordinary transurethral resection technique(A-type). Ninety cases, ranged in age from 42 to 79 years (mean; 68.0 years), were followed by interviewing with the questionaionaires concerning sexual desire, erection, vaginal penetration, orgasm and ejaculation. Loss of ejaculatory function was noted preoperatively in 4 cases of the group A and in 6 cases of the group B. Four out of 60 cases had dry ejaculation in the group in which B-type of transurethral resection of prostate was applied, while 15 out of 20 cases had dry ejaculation or anejaculation in the group A. There were 3 patients who had undergone B-type operation first and one to four years later A-type operation was also performed, and they complained of no ejaculatory disturbance after B-type operation. However, dry ejaculation did occur after A-type operation in all three patients. All 90 cases were able to achieve an erection with sexual desire preoperatively and postoperatively Seven cases of decreased orgasm were noted in the group B, while 8 cases complained of decreased orgasm in the group A. Judging from above results this modified technique of transurethral resection of prostate is a useful method to preserve normal ejaculatory function.