Objective:To explore the application of real-time transrectal ultrasound (TRUS) during seminal vesiculoscopy in infertile men with azoospermia or oligoasthenospermia.Methods:We retrospectively analyzed the clinical data of 25 cases of azoospermia or oligoasthenospermia due to ejaculate ducts obstruction who were treated with real-time transrectal ultrasound-guided seminal vesiculoscopy between September 2011 and December 2015. Patients’ age was(29.4±4.5) years. All patients accepted semen analysis, serum sex hormone, MRI, TRUS and then diagnosed as obstructive azoospermia, and 13 cases had intractable obstructive azoospermia or oligoasthenospermia after the failure of simple seminal vesiculoscopy(the path to the ejaculatory duct and seminal vesicle couldn’t be found). All patients were treated with seminal vesiculoscopy under real-time guidance with TRUS. We assessed the success rate of surgery, surgical time and complications.Results:The scope was successfully inserted into the seminal vesicle in 21 of the 25 cases (success rate, 84%). The median operative time was 75(31, 148) min. None of the patients developed severe complications. Among 4 failure cases (4/25, 16%), 1 was due to abnormal congenital development. In 2 cases, a clear outlet of the dual ejaculatory duct could not be found after it was inserted into the prostatic utricle. One case was considered as a Müllerian tubular cyst, and the seminal vesicle scope was used to assess the cystic side wall. The 21 patients were followed up for 3 to 6 months, semen volume 2.0(0-5.2)ml, total sperm 28(0-832) ×10 6/ejaculate, sperm density 5.6(0-110.3)×10 6/ml, mobility rate of sperm 5.4%(0-63.6%), and the differences were significant as compared to that before the surgery [semen volume 0.4(0-2.8)ml, total sperm 0(0-342)×10 6/ejaculate, sperm density 0(0-90.7)×10 6/ml, mobility rate of sperm 0(0-24.1%), all P<0.05]. Among the 17 patients who underwent follow-up of 5 to 9 years, 3 patients was conceived naturally and 9 patients’ postoperative sperm quality has improved and pregnancy in vitro fertilization by extracting sperm from semen. Conclusions:Intraoperative real-time transrectal ultrasound guidance can improved the success rate of seminal vesiculoscopy and promoted operative safety.

SUMMARY The mesothelium,which consists of a monolayer of mesothelial cells,extends over the sur-face of the serosal cavities(pleura,pericardium,peritoneum and tunica vaginalis).Mesothelial tumours of the tunica vaginalis is rare compared with those arise from pleura or peritoneum.According to World Health Organization 2022 Classification of Urinary and Male Genital Tumours(5th edition),mesothelial tumours of the tunica vaginalis were categorized into adenomatoid tumour,well-differentiated papillary mesothelial tumour(WDPMT)and mesothelioma.Since WDPMT of tunica vaginalis was rare,there was no consensus concerning the treatment of it.In this case report,a 29-year-old man who had endured intermittent right scrotal pain for 8 months,aggravating scrotal pain for 2 weeks was admitted.No symptoms,such as frequent,urgent,or painful urination were shown.Physical examination revealed the enlargement and tenderness of right scrotum,with no signs of lifting pain.The most recent scrotal ultrasonography be-fore surgery revealed right hydrocele with maximum depth of 4 centimeters and poor blood flow of right testis.Under the circumstance of patient's chronic history of testicular hydrocele,he underwent an emer-gency operation of right scrotal exploration and hydrocelectomy under epidural anesthesia.After opening the vagina tunic cavity,spot-like bleeding was observed on the right testicle,epididymis and vaginalis surface.The vaginalis was obviously thickened and the inner and outer walls were smooth.The post-operative histopathology revealed a grayish-brown tissue with a thickness of 0.3-0.5 cm,smooth inner and outer walls,and a suspected WDPMT with a diameter of 1.5 cm.Immunohistochemical staining showed positive for Calretinin,BAP1,WT-1,CK5/6,D2-40 and P16,which confirmed the diagnosis of WDPMT.To sum up,the purpose of this case report was to raise awareness of a rare disease WDPMT,which was usually asymptomatic and could be diagnosed by pathology and immunohistochemistry.The disease should be differentiated from testicular torsion,epididymitis,orchitis and oblique inguinal hernia in symptoms,and from malignant mesothelioma and adenomatoid tumour in pathology.Because of the rarity of the cases,there was no unified standard for the treatment of WDPMT at present.The common treatment methods reported in literature included orchidectomy and vaginectomy.Due to the lack of un-derstanding of this disease,postoperative follow-up was still recommended for at least 5 years.

Genitourinary tract malignant lymphoma is rare, and primary malignant lymphoma of the lower urinary tract is even rarer. This article reported a female patient with primary diffuse large B-cell lymphoma in the urethra. The patient was admitted due to progressive dysuria, because ultrasound indicated a lesion in the urethra, transurethral resection of the lesion was performed, which revealed diffuse large B-cell lymphoma of the urethra. R-CHOP chemotherapy regimen of four cycles was performed after surgery, and urination symptoms relieved. There was no recurrence or metastasis after 6 months of follow-up.