ObjectiveTo search for an optimal method of entering the seminal vesiculoscope based on the distribution of ejaculatory duct openings.

METHODSFifty-six patients with refractory hemospermia underwent seminal vesiculoscopy in our hospital from July 2014 to December 2016. We observed the positions of the ejaculatory duct openings under the seminal vesiculoscope, analyzed their distribution, and explored the optimal methods of entering the seminal vesiculoscope according to the success rate of operation, experience of the operators, video data and operation records.

RESULTSBased on the distribution of the positions, the ejaculatory duct openings of the patients were classified into types Ⅰ (the included angle between the medial area of the prostatic utricle edge tangent and the inferior utricle region ≤45°), Ⅱ (the included angle between the lateral area of the prostatic utricle edge tangent and the inferior utricle region >45°), and Ⅲ (the ejaculatory duct opening abnormal or located in the prostatic utricle), which accounted for 42.9% (24/56), 48.2% (27/56) and 8.9% (5/56), respectively. The success rate of entering the vesiculoscope through the natural passage was 83.3% for type Ⅰ and 29.6% for type Ⅱ openings. A bypass method was used for all the 5 cases of type Ⅲ by making a blunt puncture through the lateral wall of the prostatic utricle. Follow-up was completed in 54 of the patients, of whom 52 (96.3%) showed disappearance or significant improvement of the hemospermia symptoms at 1－3 months postoperatively.

CONCLUSIONSType Ⅱ ejaculatory duct openings are the most commonly seen clinically, and then come types Ⅰ and Ⅲ. For patients with type Ⅰ ejaculatory duct openings, the best way of entering the seminal vesiculoscope was through the natural passage, while for those with types Ⅱ and Ⅲ, the bypass method is recommended.