Arab journal of urology · 2025
The outcome of transurethral seminal vesiculoscopy regulated by Endoscopic Seminal Vesicle Milking Test in treating ejaculatory duct obstruction: A prospective cohort.
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Omar Mohamed, Amin Tarek, Badawy Atef, Selim Mohamed
Аннотация
PURPOSE: This study aimed to evaluate the effectiveness of Endoscopic Seminal Vesicle Milking Test combined with seminal vesiculoscopy with a 4.5 Fr ureteroscope as a minimally invasive approach for diagnosing and treating ejaculatory duct obstruction while preserving ejaculatory function.
MATERIALS AND METHODS: A prospective cohort study was conducted, involving 19 male patients with suspected ejaculatory duct obstruction. Endoscopic Seminal Vesicle Milking Test was used for initial diagnosis & confirming obstruction, followed by seminal vesiculoscopy using a 4.5 Fr ureteroscope. Pre- and post-operative seminal parameters, complications, and conception rates were analyzed over one year.
RESULTS: Among 19 patients, Endoscopic Seminal Vesicle Milking Test excluded 3 cases of functional obstruction, while 2 cases excluded due to lost follow-up. Among the 14 completing the protocol, 9 had successful sperm retrieval, with significant improvements in seminal parameters (volume: 1.96 ± 0.98 mL, concentration: 16.9 ± 18.4 million/mL, motility: 19.1 ± 11.7%). While in the other five patients, seminal vesiculoscopy failed to retrieve sperms. Hence, Vasography was performed and revealed obstructed vas deferens. Four patients achieved conception within a year. Minor complications included transient hematuria and hematospermia, with one case of recurrent epididymitis managed conservatively.
CONCLUSION: The combination of Endoscopic Seminal Vesicle Milking Test and seminal vesiculoscopy offers a promising, minimally invasive solution for ejaculatory duct obstruction, demonstrating favorable outcomes in sperm retrieval and conception rates with minimal complications. Further multicenter trials are recommended to validate these findings.
MATERIALS AND METHODS: A prospective cohort study was conducted, involving 19 male patients with suspected ejaculatory duct obstruction. Endoscopic Seminal Vesicle Milking Test was used for initial diagnosis & confirming obstruction, followed by seminal vesiculoscopy using a 4.5 Fr ureteroscope. Pre- and post-operative seminal parameters, complications, and conception rates were analyzed over one year.
RESULTS: Among 19 patients, Endoscopic Seminal Vesicle Milking Test excluded 3 cases of functional obstruction, while 2 cases excluded due to lost follow-up. Among the 14 completing the protocol, 9 had successful sperm retrieval, with significant improvements in seminal parameters (volume: 1.96 ± 0.98 mL, concentration: 16.9 ± 18.4 million/mL, motility: 19.1 ± 11.7%). While in the other five patients, seminal vesiculoscopy failed to retrieve sperms. Hence, Vasography was performed and revealed obstructed vas deferens. Four patients achieved conception within a year. Minor complications included transient hematuria and hematospermia, with one case of recurrent epididymitis managed conservatively.
CONCLUSION: The combination of Endoscopic Seminal Vesicle Milking Test and seminal vesiculoscopy offers a promising, minimally invasive solution for ejaculatory duct obstruction, demonstrating favorable outcomes in sperm retrieval and conception rates with minimal complications. Further multicenter trials are recommended to validate these findings.