Original Article: Clinical Investigation
Transurethral seminal vesiculoscopy acts as a therapeutic
investigation for intractable hemospermia: Step-by-step illustrations
and single-surgeon experience
Ju-Chuan Hu and Chuan-Shu Chen
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Abbreviations & Acronyms
MRI = magnetic resonance
PSA = prostate-speciﬁc
SV = seminal vesicle
TRUS = transrectal
TUSV = transurethral
Chen M.M., Division of
Urology, Department of
Surgery, Taichung Veterans
General Hospital, Taiwan
Boulevard, Taichung, Taiwan.
Received 21 December 2017;
accepted 22 February 2018.
Online publication 17 April
Objective: To describe the methodology of transurethral seminal vesiculoscopy and
the anatomy of the seminal tract, and to report a single-surgeon experience with this
Methods: A total of 38 consecutive patients with intractable macroscopic
hemospermia were enrolled from January 2010 to July 2016. A 6/7.5-Fr semirigid
ureteroscope was used to enter the seminal tract by one of these two approaches:
through either a trans-ejaculatory duct opening or a trans-utricle fenestration. Patient
characteristics and their preoperative and postoperative measurements were analyzed
Results: The success rate of transurethral seminal vesiculoscopy was 92.1%, whereas
the approaching method in most patients was the trans-utricle fenestration (88.89%). A
total of 34 (94.4%) transurethral seminal vesiculoscopy inspections ended with complete
remission, even though nearly half of them (47.2%) only disclosed negative perioperative
ﬁndings. The median period to complete remission was 4 weeks (interquartile range 4–
6 weeks) after the procedure. Four patients had recurrent hemospermia, and the median
time to recurrence was 21.5 (range 13–48.5) months.
Conclusions: Transurethral seminal vesiculoscopy is a valuable diagnostic tool for
intractable hemospermia, and also plays a therapeutic role by blocking the vicious cycle
of stasis, calculi and seminal vesiculitis. More familiarity of the anatomy and enough
practice would make the learning curve less steep.
diagnosis, hemospermia, therapy, transurethral seminal vesiculoscopy.
Hemospermia might be a primary symptom of some serious diseases involving the male semi-
nal tract, including infection, inﬂammation, ductal obstruction, neoplasm, trauma, iatrogenic
injury and some systemic diseases, such as severe hypertension or hematological diseases.
However, hemospermia is usually a benign and self-limiting disease. Amano et al. reported
that 57% of hemospermia patients have symptom remission 1 month after the initial episode.
The relative benign nature of hemospermia raises the diagnostic dilemma regarding the opti-
mal timing for investigation and speciﬁcally which population of patients requires simple
reassurance instead of an invasive procedure for evaluation.
Current imaging examinations used for the differential diagnosis of hemospermia include
the TRUS, pelvic computed tomography and MRI. However, all these examinations play only
diagnostic roles and might result in a false negative if there are small lesions. TUSV, in con-
trast, provides a direct visual examination for the interior of the seminal tract and also a thera-
peutic beneﬁt concurrently. Xing et al. even reported that TUSV offers a higher diagnostic
yield than TRUS (74.5% vs 45.3%, P < 0.001).
However, TUSV is indeed a challenging procedure for surgeons who are just starting to
use the procedure. We intend to show the anatomy of the seminal tract and describe the
methodology of the TUSV approach using a 6/7.5-Fr ureteroscope. Although the surgical
technique was similar to previous studies, the present study aimed to offer more comprehen-
sive anatomy with cross-section illustrations and to make the learning curve of this procedure
© 2018 The Japanese Urological Association
International Journal of Urology (2018) 25, 589--595 doi: 10.1111/iju.13569