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王增军
王增军主任医师 教授江苏省人民医院 泌尿外科

BJU Int. 2010 Oct 15. doi: 10.1111/j.1464-410X.2010.09775.x. [Epub ahead of print]

Novel methods for the diagnosis and treatment of ejaculatory duct obstruction.

Laboratory of Reproductive Medicine, Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 江苏省人民医院泌尿外科王增军

Abstract

Study Type - Therapy (case series)
Level of Evidence 4

OBJECTIVES: • To investigate a new method of vas deferens radiography for ejaculatory duct obstruction (EDO). • To evaluate the effect of a procedure involving dilation of the ejaculatory duct by F9 seminal vesicoscopy.

PATIENTS AND METHODS: • Twenty-two patients with EDO were diagnosed using semen analysis, semen fructose measurement, transrectal ultrasonography (TRUS) and vas deferens radiography. • Of these, 18 patients were successfully treated by dilation of ejaculatory duct using F9 seminal vesicoscopy and four patients, whose treatment was unsuccessful, were treated by transurethral resection of the ejaculatory ducts (TURED). • All patients were followed up for at least 3 months after treatment.

RESULTS: • Semen analyses in all 22 patients showed oligoasthenozoospermia or azoospermia, low semen volume (0-1.9 mL), low pH level (5.6-7.0) and absent or low semen fructose. TRUS and radiography showed pure dilated seminal vesicles on both sides in three patients, partial dilated seminal vesicles in one patient, dilation of both the ejaculatory duct and seminal vesicles in ten patients, dilated seminal vesicles and a prostatic cyst in four patients, and dilated ejaculatory duct or cystic lesions without dilated seminal vesicles in the remaining four patients. • At >3-month follow-up after dilation or TURED, the semen characteristics of 18 patients were improved and sperm were present in the semen in 13 cases. Normal semen analyses were found in 7 patients and 6 patients had conceived. • Voiding urethral radiography showed that no patients who had undergone dilation by seminal vesicoscopy had urine reflux into the ejaculatory duct. Only one patient showed urine reflux into the seminal vesicle after TURED. • All patients felt that their symptoms had improved after treatment.

CONCLUSION: • The approach to vas deferens radiography using vas deferens aspiration has proved to be an effective and safe method for EDO diagnosis. • The procedure involving the dilation of the ejaculatory duct using F9 seminal vesicoscopy is equally effective but has fewer postoperative complications than TURED.

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发布时间:2011-01-30 18:34

王增军主任医师 教授
江苏省人民医院 泌尿外科
擅长:肾癌前列腺癌膀胱癌的诊治,男性不育性功能障碍的诊治;机器人辅助腹腔镜下复杂性泌尿生殖系统肿瘤如肾癌根治及保留肾单位肾部分切除术,保留性神经膀胱癌根治性切除原位新膀胱术,保留性神经及尿控功能前列腺癌根治术,睾丸癌腹膜后淋巴结清扫等微创治疗,尿道断裂尿道修复重建手术,泌尿生殖系统先天性畸形如肾盂输尿管连接部狭窄和小儿尿道下裂修复重建等。前列腺增生症微创治疗,男性勃起功能障碍假体植入,血精的微创治疗,男性不育(少弱精及无精子症)的诊治等。 << 收起

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