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Transurethral seminal
vesiculoscopy : hype or hope
Prof Chui Ka Lun , Hong Kong, China
Private urologist
FRCS Edin(Uro) FHKAM
Hon Assistant Prof
The Chinese University of Hong Kong
Declaração de Conflitos de Interesse*
NOTHING FOR DISCLOSURE
Hemospermia Definition
● Acute
Infectious
Non infectious = Sporadic
● Chronic
Persistent, on and off, >3 months
● Chronic Resistant (Intractable)
Persistent, on and off, >3 months; Resistant to antibiotic treatment (quinolone 4 weeks)
Western guidelines
AUA EAU etc guidelines
on Prostatitis
Chronic prostatitis
CPPS
Shouled be revised
esp on Hemospemia
Hemospermia is not NOTHING
it’s reflecting status of prostate
“Prostate and Seminal Vesicles” Anatomically are 2 organs
should be always “1 functional organ”
Patient know something wrong is
happening while ……
the Consultant knows nothing about
it and pretends he knows it’s alright
and sweep it under the carpet
Hemospermia Clinic
Urologists reply Tweets/ even real world consultation
“Sir, just ignore it ! Turn off the night while you ejaculate, pretend nothing happens!”
Prostatitis usually associated with
seminal vesiculitis
Situations
1. Blocked Utricular opening
2. Blocked Ejaculatory Duct Openings
3. Blocked Ejaculatory Ducts
4. Seminal vesiculitis
5. BPH TZ compression
6. BPH pathology on HOLEP:
a. Benign Prostate Hyperplasia ,
i. + Acute on Chronic prostatitis
Endourology in reproductive system
Endourology in reproductive system
Hu, J.-C. and Chen, C.-S. (2018), Transurethral seminal vesiculoscopy acts as
a therapeutic investigation for intractable hemospermia: Step-by-step
illustrations and single-surgeon experience. Int. J. Urol., 25: 589-595.
https://doi.org/10.1111/iju.13569
New horizon
Anatomy
Microbiome
Prostate vs seminal vesicles vs bladder
Anatomical study of the seminal vesicle system
for transurethral seminal vesiculoscopy
Li, Z.Y., Xu, Y., Liu, C., Xiao, Z.M., Luo, B.H., Xu,
G.W., Wu, K.C., Zhong, S.Z. and Ouyang, J. (2019),
Anatomical study of the seminal vesicle system for
transurethral seminal vesiculoscopy. Clin Anat, 32:
244-252. https://doi.org/10.1002/ca.23293
Microanatomy
Pathological review: (a) the verumontanum was split in the middle of the sagittal plane. (b) The
histological structure of the ejaculatory duct, the verumontanum, and the membrane between them.
New horizon
Microbiome
Prostate vs seminal vesicles vs bladder
Urine is NOT sterile
Semen is NOT sterile
Scott D. Lundy, Naseer Sangwan, Neel V. Parekh, Manesh Kumar Panner
Selvam, Sajal Gupta, Peter McCaffrey, Kovi Bessoff, Ayin Vala, Ashok Agarwal,
Edmund S. Sabanegh, Sarah C. Vij, Charis Eng,
Functional and Taxonomic Dysbiosis of the Gut, Urine, and Semen
Microbiomes in Male Infertility,
European Urology,
Volume 79, Issue 6,
2021,
Pages 826-836,
ISSN 0302-2838,
https://doi.org/10.1016/j.eururo.2021.01.014.
Misconception?
Semen c/st usefulness?
known vs unknown from laboratory
still quinolone is the only choice
for blood/SV/prostate barrier
How to Diagnose?
CPPS
Chronic pelvic pain syndrome
Diagnosis acute and chronic prostatitis is a clinical diagnosis
How to Diagnose?
History
P/E
Bedside USG
DRE
How to Diagnose?
History
Pain at urethra
Pain at whole glans
urethral clear discharge
dull pain suprapubic area and bilateral scrotum
low back pain
occasional inner thigh lumpness
perineal pain
Gross anatomy concerned
Utricle
Ejaculatory openings
Ejaculatory duct
Seminal Vesicles
Vas Deferns
Epididymis
Testis
Prostatitis usually associated with
seminal vesiculitis
Prostatic calcifications/stones
accompanied with blocked prostatic ducts
associated with inflammation(likely)
+/- bacteria that is infection
Discomfort<—>Pain
Myth therefore named syndrome
“CPPS”
Ejaculatory system is a mysterious land
no specific treatment to deal with it
Vidoes Sharing
Videos
True world video
Transurethral seminal vesiculoscopy for intractable
hematospermia: experience from 144 patients
Chen, WK., Yu, DD., Chen, ZX. et al.
Transurethral seminal vesiculoscopy for
intractable hematospermia: experience from
144 patients. BMC Urol 21, 48 (2021).
https://doi.org/10.1186/s12894-021-00817-4
144 patients with intractable hematospermia
Transurethral seminal vesiculoscopy was successfully
performed in 139 patients (96.53%).
Common intraoperative manifestations were
hemorrhage, stones, utricle polyps and cysts.
The surgical approach in our study were categorized into
four types, including 24 (16.7%), 73 (50.7%), 42 (29.2%),
and 5 (3.5%) cases in Type A (natural opening of the
ejaculatory duct), B (trans-duct fenestration), C (trans-
utricle fenestration), and D (not founded)
Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419
cases
Chen Rui, Wang Lei, Sheng Xia, Piao Shu-Guang, Nian Xin-Wen, Cheng Xin, Zhou Tie, Li Hui-Zhen, Liu Ya-Wei, Chen Guang-Hua, Zhang Chun-Lei, Kong
De-Pei, Xiao Guang-An, Lu Xin, Jia Zhen-Yu, Liu Zhi-Yong, Sun Ying-Hao
Year : 2018 | Volume: 20 | Issue Number: 5 | Page: 438-441
Routes
Endoscopic patterns of the orifice of the ejaculatory duct and the
surgical path in Type A patients where the orifice of the ejaculatory
duct could be observed from the urethra (a); in Type B patients, the
ejaculatory duct and the verumontanum were only separated by a
thin layer of white membrane-like tissue on the left side (b) or on
both sides (c); the membrane-like tissue was not identified at first
sight in Type C patients (d), and tentative puncture at the
membrane-like tissue were performed in the same patient (e);
pressure changes indicated the suspected location for tentative
puncture (f) and tentative puncture performed at the suspected
location in Type C patients (g); the surgical pathway was established
after the tentative puncture in Type C patients (h); the surgical path
could not be established in Type D patients (i).
Pathology
Chen R, Wang L, Sheng X, Piao SG, Nian XW, Cheng X,
Zhou T, Li HZ, Liu YW, Chen GH, Zhang CL, Kong DP,
Xiao GA, Lu X, Jia ZY, Liu ZY, Sun YH. Transurethral
seminal vesiculoscopy for recurrent hemospermia:
experience from 419 cases. Asian J Androl 2018;20:438-
41
Endoscopic view of the seminal tract. (a) Opening of
the verumontanum; (b) orifice of the verumontanum;
(c) calculus in the ejaculatory duct; (d) grasping
forceps applied for removal of calculus in the
ejaculatory duct; (e) normal seminal vesicle; (f)
inflammatory lesions in the seminal vesicle.
Operation record
Drawings to document
1. Endoscopic findings
2. Routes chosen
3. Endoscopic “Diagnosis”
4. Endoscopic “Treatment”
Same day self void
and dischage if well
Keep Contact
Twitter: chuikalun
Email: chuikalunurology@gmail.com
YouTube Channel: Chui Ka Lun
OBRIGADO!
Chuikalun Twitter
chuikalunurology@gmail,com
Chuikalun Linkedin
@drchuikalun
THANK YOU
True world video
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NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
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NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE
True world video
NOTHING FOR DISCLOSURE

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Transurethral seminal vesiculoscopy for chronic pelvic pain syndrome CPPS / intractable hemospermia

  • 1. Transurethral seminal vesiculoscopy : hype or hope Prof Chui Ka Lun , Hong Kong, China Private urologist FRCS Edin(Uro) FHKAM Hon Assistant Prof The Chinese University of Hong Kong
  • 2. Declaração de Conflitos de Interesse* NOTHING FOR DISCLOSURE
  • 3. Hemospermia Definition ● Acute Infectious Non infectious = Sporadic ● Chronic Persistent, on and off, >3 months ● Chronic Resistant (Intractable) Persistent, on and off, >3 months; Resistant to antibiotic treatment (quinolone 4 weeks)
  • 4. Western guidelines AUA EAU etc guidelines on Prostatitis Chronic prostatitis CPPS Shouled be revised esp on Hemospemia Hemospermia is not NOTHING it’s reflecting status of prostate “Prostate and Seminal Vesicles” Anatomically are 2 organs should be always “1 functional organ”
  • 5. Patient know something wrong is happening while …… the Consultant knows nothing about it and pretends he knows it’s alright and sweep it under the carpet Hemospermia Clinic Urologists reply Tweets/ even real world consultation “Sir, just ignore it ! Turn off the night while you ejaculate, pretend nothing happens!”
  • 6. Prostatitis usually associated with seminal vesiculitis Situations 1. Blocked Utricular opening 2. Blocked Ejaculatory Duct Openings 3. Blocked Ejaculatory Ducts 4. Seminal vesiculitis 5. BPH TZ compression 6. BPH pathology on HOLEP: a. Benign Prostate Hyperplasia , i. + Acute on Chronic prostatitis
  • 8. Endourology in reproductive system Hu, J.-C. and Chen, C.-S. (2018), Transurethral seminal vesiculoscopy acts as a therapeutic investigation for intractable hemospermia: Step-by-step illustrations and single-surgeon experience. Int. J. Urol., 25: 589-595. https://doi.org/10.1111/iju.13569
  • 9. New horizon Anatomy Microbiome Prostate vs seminal vesicles vs bladder
  • 10. Anatomical study of the seminal vesicle system for transurethral seminal vesiculoscopy Li, Z.Y., Xu, Y., Liu, C., Xiao, Z.M., Luo, B.H., Xu, G.W., Wu, K.C., Zhong, S.Z. and Ouyang, J. (2019), Anatomical study of the seminal vesicle system for transurethral seminal vesiculoscopy. Clin Anat, 32: 244-252. https://doi.org/10.1002/ca.23293
  • 11. Microanatomy Pathological review: (a) the verumontanum was split in the middle of the sagittal plane. (b) The histological structure of the ejaculatory duct, the verumontanum, and the membrane between them.
  • 12. New horizon Microbiome Prostate vs seminal vesicles vs bladder Urine is NOT sterile Semen is NOT sterile Scott D. Lundy, Naseer Sangwan, Neel V. Parekh, Manesh Kumar Panner Selvam, Sajal Gupta, Peter McCaffrey, Kovi Bessoff, Ayin Vala, Ashok Agarwal, Edmund S. Sabanegh, Sarah C. Vij, Charis Eng, Functional and Taxonomic Dysbiosis of the Gut, Urine, and Semen Microbiomes in Male Infertility, European Urology, Volume 79, Issue 6, 2021, Pages 826-836, ISSN 0302-2838, https://doi.org/10.1016/j.eururo.2021.01.014.
  • 13. Misconception? Semen c/st usefulness? known vs unknown from laboratory still quinolone is the only choice for blood/SV/prostate barrier
  • 14. How to Diagnose? CPPS Chronic pelvic pain syndrome Diagnosis acute and chronic prostatitis is a clinical diagnosis
  • 16. How to Diagnose? History Pain at urethra Pain at whole glans urethral clear discharge dull pain suprapubic area and bilateral scrotum low back pain occasional inner thigh lumpness perineal pain
  • 17. Gross anatomy concerned Utricle Ejaculatory openings Ejaculatory duct Seminal Vesicles Vas Deferns Epididymis Testis
  • 18. Prostatitis usually associated with seminal vesiculitis Prostatic calcifications/stones accompanied with blocked prostatic ducts associated with inflammation(likely) +/- bacteria that is infection Discomfort<—>Pain
  • 19. Myth therefore named syndrome “CPPS” Ejaculatory system is a mysterious land no specific treatment to deal with it
  • 22. Transurethral seminal vesiculoscopy for intractable hematospermia: experience from 144 patients Chen, WK., Yu, DD., Chen, ZX. et al. Transurethral seminal vesiculoscopy for intractable hematospermia: experience from 144 patients. BMC Urol 21, 48 (2021). https://doi.org/10.1186/s12894-021-00817-4 144 patients with intractable hematospermia Transurethral seminal vesiculoscopy was successfully performed in 139 patients (96.53%). Common intraoperative manifestations were hemorrhage, stones, utricle polyps and cysts. The surgical approach in our study were categorized into four types, including 24 (16.7%), 73 (50.7%), 42 (29.2%), and 5 (3.5%) cases in Type A (natural opening of the ejaculatory duct), B (trans-duct fenestration), C (trans- utricle fenestration), and D (not founded)
  • 23. Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases Chen Rui, Wang Lei, Sheng Xia, Piao Shu-Guang, Nian Xin-Wen, Cheng Xin, Zhou Tie, Li Hui-Zhen, Liu Ya-Wei, Chen Guang-Hua, Zhang Chun-Lei, Kong De-Pei, Xiao Guang-An, Lu Xin, Jia Zhen-Yu, Liu Zhi-Yong, Sun Ying-Hao Year : 2018 | Volume: 20 | Issue Number: 5 | Page: 438-441
  • 24. Routes Endoscopic patterns of the orifice of the ejaculatory duct and the surgical path in Type A patients where the orifice of the ejaculatory duct could be observed from the urethra (a); in Type B patients, the ejaculatory duct and the verumontanum were only separated by a thin layer of white membrane-like tissue on the left side (b) or on both sides (c); the membrane-like tissue was not identified at first sight in Type C patients (d), and tentative puncture at the membrane-like tissue were performed in the same patient (e); pressure changes indicated the suspected location for tentative puncture (f) and tentative puncture performed at the suspected location in Type C patients (g); the surgical pathway was established after the tentative puncture in Type C patients (h); the surgical path could not be established in Type D patients (i).
  • 25. Pathology Chen R, Wang L, Sheng X, Piao SG, Nian XW, Cheng X, Zhou T, Li HZ, Liu YW, Chen GH, Zhang CL, Kong DP, Xiao GA, Lu X, Jia ZY, Liu ZY, Sun YH. Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases. Asian J Androl 2018;20:438- 41 Endoscopic view of the seminal tract. (a) Opening of the verumontanum; (b) orifice of the verumontanum; (c) calculus in the ejaculatory duct; (d) grasping forceps applied for removal of calculus in the ejaculatory duct; (e) normal seminal vesicle; (f) inflammatory lesions in the seminal vesicle.
  • 26. Operation record Drawings to document 1. Endoscopic findings 2. Routes chosen 3. Endoscopic “Diagnosis” 4. Endoscopic “Treatment” Same day self void and dischage if well
  • 27. Keep Contact Twitter: chuikalun Email: chuikalunurology@gmail.com YouTube Channel: Chui Ka Lun
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