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Introduction There have been problems with low qualification operator-related complications and failures of transurethral seminal vesiculoscopy (TSV) in China. Aim To study the guiding role of seminal tract anatomical study (STAS) in TSV. Material and methods We performed STAS to study the structure, morphology, duct trajectory, and anatomical relationships between the seminal vesicles and the adjacent tissue in pelvic specimens from 12 adult cadavers. Then the surgical effects and complications of 82 cases of TSV performed by 3 doctors were retrospectively studied to compare the difference between the two groups of before and after the anatomical study. Results The anatomical studies of the 12 adult cadaveric pelvis specimens identified the lengths and widths of the right- and left-side seminal vesicles and tracts. The TSV can treat lesions located in the distal seminal tract and vesicle, but proximal lesions cannot be reached, which is an anatomical limitation of this technique. There were significant differences in the surgical times and the surgical validity rates between the 2 groups. Conclusions Our anatomical study of the seminal tract and seminal vesicles is valuable for guiding TSV in clinical practice.

Inguinal herniorraphy is a possible cause of iatrogenic seminal tract obstruction. Diagnosing and correcting these vasal injuries can be challenging. Successful re-anastomosis is technically challenging, with relatively low success rates. An uncommon alternative for selected cases is the crossover transseptal vasovasostomy. We herein report a case of a 36-year-old male patient with vas deferens injury after herniorraphy and a contralateral hypotrophic testis. He was successfully treated through microsurgical crossover transseptal vasovasostomy, with spontaneous pregnancy achieved, and the technique is presented in details.

Congenital bilateral absence of the vas deferens (CBAVD) is a rare obstructive anomaly contributing to male factor infertility. Various congenital anomalies associated with CBAVD involve the seminal vesicles and epididymis. Physical examinations are often not reliable. However, transrectal ultrasonography (TRUS) can distinguish seminal vesicle and epididymal anomalies. In this clinical report, a rare case of CBAVD without seminal vesical anomalies is presented. PE and TRUS revealed no remarkable findings. The patient underwent vaso-epididymal anastomosis for the seminal tract obstruction and was accidentally diagnosed with CBAVD. Although ultrasonography is a reliable approach, surgical methods are critical for the diagnosis of CBAVD.

We summarized our experience in transurethral seminal vesiculoscopy (TSV) for recurrent hemospermia by introducing surgical techniques, intraoperative findings, and treatment outcomes. TSV was performed in 419 patients with an initial diagnosis of persistent hemospermia at Shanghai Changhai Hospital (Shanghai, China) from May 2007 to November 2015. TSV was successfully performed in 381 cases (90.9%). Hemospermia was alleviated or disappeared in 324 (85.0%) patients by 3 months after surgery. Common intraoperative manifestations were bleeding, obstruction or stenosis, mucosal lesions, and calculus. Endoscopic presentation of the ejaculatory duct orifice and the verumontanum was categorized into four types, including 8 (1.9%), 32 (7.6%), 341 (81.4%), and 38 (9.1%) cases in Types A, B, C, and D, respectively. TSV is an effective and safe procedure in the management of seminal tract disorders. This study may help other surgeons to become familiar with and improve this procedure. However, further multicentric clinical trials are warranted to validate these findings.

Purpose To investigate the incidence, etiology, treatment indications, and outcomes regarding infertile male patients in Japan. Methods Between April, 2014 and March, 2015, the authors contacted 47 clinical specialists in male infertility who had been certified by the Japan Society for Reproductive Medicine. The participating clinicians were sent a questionnaire regarding information on their infertile patients, according to etiology and the number and success rates of male infertility operations that had been performed in their practice. Results Thirty-nine specialists returned the questionnaire and provided information regarding 7268 patients. The etiology of infertility included testicular factors, sexual disorders, and seminal tract obstruction. During the study year, the clinicians performed varicocelectomies, testicular sperm extractions (TESEs), and re-anastomoses of the seminal tract. The rate of successful varicocelectomies was >70%. The sperm retrieval rates with conventional TESE and microdissection TESE were 98.3% and 34.0%, respectively, while the patency rates with vasovasostomy and epididymovasostomy were 81.8% and 61.0%, respectively. Conclusion Surgical outcomes for infertile male patients are favorable and can be of great clinical benefit for infertile couples. To achieve this, urologists should work in collaboration with gynecological specialists in order to optimize the treatment of both partners.

Senile Seminal Vesicle Amyloidosis (SSVA) increases with age. Involvement of the whole seminal tract, i.e. the seminal vesicles, ejaculatory and deferent ducts was first reported by us in the International Symposium on Amyloidosis 1998. Since then we encountered four more cases of SSVA. In all these cases the ejaculatory and deferent ducts were also involved by amyloid. The amyloid was located mostly sub-epithelially, stained positively with Congo red, gave green birefringence under polarized light and was permanganate sensitive, slightly positive for lactoferrin immunostaining and negative for all known amyloid types. In recent years the amyloid was found to be derived from Semenogelin I, a major constituent of the seminal fluid which is present in the epithelial cells of the seminal vesicle and vas deference. This would explain the deposition of amyloid not only in the seminal vesicles but also in the deferent an ejaculatory ducts which transport the seminal fluid. In a review of the literature we found three more articles on SSVA in which the amyloid was not limited to the seminal vesicles alone. We propose to designate this type of amyloid as "Senile seminal Tract Amyloidosis" (SSTA) instead of "Senile Seminal Vesicle Amyloidosis (SSVA)".

Zinner syndrome (ZS) could represent an uncommon cause of male infertility, as result of the ejaculatory duct block, which typically leads to low seminal volume and azoospermia. A 27-year-old Caucasian man reported persistent events of scrotal-perineal pain and dysuria during the past 6 months. The andrological examination showed testicular volume of 10 ml bilaterally. Follicle-stimulating hormone was 32.0 IU/L, luteinising hormone was 16.3 IU/L, total testosterone was 9.0 nmol/L, and 17-beta-oestradiol was 0.12 nmol/L. The semen analysis revealed absolute azoospermia, semen volume of 0.6 ml and semen pH of 7.6. The abdominal contrast-enhanced computed tomography showed (a) left kidney agenesis; (b) an ovaliform hypodense mass of 65 × 46 millimetres with fluid content, which was shaping the bladder and the left paramedian prostatic region, compatible with a left seminal vesicle pseudocyst; and (c) an enlargement of the right seminal vesicle. The patient was diagnosed with ZS, and he was scheduled for robot-assisted laparoscopic left vesiculectomy. Subsequently, testis biopsy was characterised by complete germ cell aplasia. The onset symptomatology is often blurred and difficult to detect. It is important to diagnose and manage early this condition, because a long-lasting seminal tract obstruction could determine an irreversible secretory testicular injury.

This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0–97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0–18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

Ectopic seminal tract opening is a rare congenital malformation. Until recently, there has been a lack of comprehensive reporting on the condition. The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years. We conducted auxiliary examinations on such patients including routine tests, imaging examinations, and endoscopy. Among these 28 cases, there were ectopic opening of vas deferens into enlarged prostatic utricles (6 cases); ejaculatory ducts into enlarged prostatic utricles, Müllerian ducts cysts, and urethras (18 cases, 2 cases, and 1 case, respectively); and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle (1 case). The size of the enlarged prostatic utricle, the type of ectopic seminal tract opening, and the opening's location effectively assisted in the selection of clinical treatment methods, including transurethral fenestration of the utricle, transurethral cold-knife incision, open operation, laparoscopic operation, and conservative treatment. Satisfactory effect was achieved during follow-up. In conclusion, a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.

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 procedure. 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 retrospectively. 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.

The ultrasound of prostate and seminal vesicles provides several morphological and functional information in noninvasive and fast way. The approach can be transabdominal or transrectal, with the help of different kinds of probes. The transrectal approach is the most frequently used, especially when a precise and rapid measure of the dimensions of the prostate is necessary, together with the evaluation of the presence of anatomical anomalies (third lobe, calcification, embryological residues). The study of the seminal vesicles is preferable with transrectal approach, especially in case of suspicious anomalies of the seminal tract or inflammations.

Childhood inguinal herniorrhaphy is one common cause of seminal tract obstruction. Vasovasostomy (VV) can reconstruct seminal deferens and result in appearance of sperm and natural pregnancy in some patients. Secondary epididymal obstruction caused by a relatively long-term vasal obstruction is a common cause of lower patency compared with VV due to vasectomy in adults. From July 2007 to June 2012, a total of 62 patients, with history of childhood inguinal herniorrhaphy and diagnosed as obstructive azoospermia were treated in our center. The overall patency rate and natural pregnancy rate were 56.5% (35/62) and 25.8% (16/62), respectively. 48.4% (30/62) of the patients underwent bilateral VV in the inguinal region, with a patency rate of 76.7% (23/30) and a natural pregnancy rate of 36.7% (11/30), respectively. 30.6% (19/62) of the patients underwent bilateral VV and unilateral or bilateral vasoepididymostomies due to ipsilateral epididymal obstruction with the patency and natural pregnancy rate decreasing to 63.2% (12/19) and 26.3% (5/19). 21.0% (13/62) of the patients merely underwent vasal exploration without reconstruction due to failure to find distal vasal stump, etc. Our study indicate that microsurgical reanastomosis is an effective treatment for some patients with seminal tract obstruction caused by childhood inguinal herniorrhaphy.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most prevalent inherited disorders in the world. It's a systemic disease with preferential renal involvement. However, many other organs can be affected, causing important morbidity. Some cases of male infertility are described in literature. That seems to be related to abnormalities in spermatozoa tail microtubules, atonicity and dilatation of seminal vesicle or distal seminal tract cysts and anomalies associated with chronic renal failure. This article presents a patient who combines the two major mechanisms described in literature for male infertility in ADRKD: immotile spermatozoa and megavesicles. This coincidence supports the idea of a common etiological factor to kidney and infertility anomalies.© 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.

Objective To show the flexibility in magnetic resonance imaging (MRI) of seminal vesicle (SV) and intra-abdominal segment of vas deferens for the patients with congenital absence of the vas deferens (CAVD), including congenital bilateral absence of the vas deferens (CBAVD) and congenital unilateral absence of vas deferens (CUAVD). Methods Fourteen consecutive patients with CAVD had transrectal ultrasonography (TRUS) and further MRI evaluations. TRUS was performed using a 7.5-MHz transducer, and images of the SVs were obtained, calculated in the transaxial plane. MRI studies were performed with a 1.5-7 superconducting system, T1- and T2-weighted axial, coronal, and sagittal imaging of the pelvis was obtained. If the SVs were present, then their size was measured for the morphologic classification and diagnosis. All of the patients also received cystic fibrosis transmembrane conductance regulator ( CFTR ) gene mutation testing. Results In a series of 12 men with CBAVD, only 4 were found to have bilateral SV agenesis using MRI. The remaining 8 men with unilateral hypoplasia still had SV remnants. MRI also detected the intra-abdominal segment of the vas deferens. Through our study of MRI, SV agenesis is not well associated with the presence of CFTR mutation in patients with CAVD. Conclusion MRI provides a precise imaginal diagnosis of SV defect, which is superior to the TRUS examination for the patients with CAVD. Compared with the previous inaccurate examination method of TRUS, this study demonstrates that MRI can provide better images for the patients with CAVD for the clinical diagnosis of existing defects of internal seminal tract and internal organs.

BACKGROUND: Seminal tract infections alter the semen quality and affect the sperm parameters of men with varying degree of effect to male fertility. OBJECTIVES: This study was carried out to investigate the presence of infectious agents other than sexually transmitted infections in semen and their relation to semen parameters. METHODS: Five hundred and eighty-seven semen samples of males investigated for infertility were analyzed, inoculated on sterile culture media, and incubated for 24hrs at 37 o C. The isolates were identified by standard biochemical tests and their antimicrobial susceptibility determined. RESULTS: Fifty-four percent of the samples had normal sperm concentration, 41.1% had oligospermia, and 4.9% had azoospermia. About 64.7% had normal viscous consistency, 23.0% were high viscous, and 12.3% low viscous. Also, 19.4% had highly motile permatozoa, 51.5% moderately, 27.6% poorly and 1.6% entirely non-motile spermatozoa. About 55.9% of the samples were infected with different nonspecific pathogens. CONCLUSSION: 55.9% of the semen samples were infected and this significantly affected the semen parameters. It is necessary to investigate male partners of infertile couples for infections and appropriate treatment initiated.

Objectives: The most common pathologies of the seminal tract are persistent hematospermia, seminal vesicle stones, and seminal duct obstruction. Endoscopic diagnostic work-up of the semina...

The most common pathologies of the seminal tract are persistent hematospermia, seminal vesicle stones, and seminal duct obstruction. Endoscopic diagnostic work-up of the seminal tract is impeded by complex anatomy and lack of technical equipment. To date, there is no standardized endoscopic approach. The purpose of this study was to investigate the applicability and feasibility of a flexible microoptical device for atraumatic endoscopy of the seminal tract in a male human cadaver.The transurethral endoscopic examination was performed on a male cadaver. No premortal interventions or diseases of the genitourinary tract had been reported. The seminal orifice was identified via cystoscopy and accessed by the Seldinger technique using a hydrophilic guidewire and ureteral catheter. Retrograde endoscopic inspection of the distal seminal tract was performed using a miniaturized flexible endoscope. An antegrade endoscopic inspection of the seminal tract was carried out via high scrotal access to the vas deferens.Structures of the seminal tract, such as the ejaculatory duct, seminal vesicles, and distal portion of the ductus deferentes, were visualized using the miniaturized endoscope. Image quality allowed identification of anatomical structures and characterization of tissue properties. The technical limitations we observed involved the system's maneuverability.Initial results of this novel endoscopic approach to the seminal tract using a flexible microoptical system are encouraging. However, considerable anatomical limitations of the targeted organs necessitate further refinements of the technical equipment. This approach might improve diagnostics and treatment of genitourinary diseases. Future surgical techniques may include intraseminal laser therapy or endoocclusion to monitor fertility in men.

The presence of bacteria in semen could induce impairment of sperm morphology, alteration of sperm function and mechanical or functional obstruction of the seminal tract. The term of bacteriospermia does not signify infection. Bacteriospermia and male accessory gland infection (MAGI) have indeed to be distinguished. They may lead both to male infertility but their diagnosis and treatment options differ. This review summarizes effects of bacteria and leucocytospermia on sperm parameters and functions. Then, indications, benefits and risks of treatment of bacteriospermia and MAGI, in assisted reproductive techniques (ART) will be discussed. For bacteria commonly observed in semen, this review aims at defining some thresholds above which a treatment is required. These thresholds were established according to literature, according to French microbiology society and in function of our usual practice. This review should help practitioners of reproductive medicine to take care of bacteriospermia in semen.

Introduction: Antibiotics are the principal treatment of seminal tract infections Our objective is to determine the efficacy of levofloxacin in the eradication of genital tract patogens in infertile patients comparing 28 with 56 days of treatment and to elucidate different seminal parameters availables as markers of antibiotic efficacy in seminal improvement. Materials and Methods: We studied prospectively 50 males patients with seminal tract infections. All patients were treated with levofloxacin 500 mg orally along 28 or 56 days. Two seminal analysis were performed before and after treatment an seminal parameters included TUNEL and nitric oxide levels in seminal plasma were measured. Results: We observed significative differences between both diagrams of treatment. Sperm count and motility increased significatively after treatment. But, sperm morphology do not improve after antibiotic. Necrospermy index but not leucocitospermy had been reduced after levofloxacin. Nitric oxide levels have a direct correlation with sperm count but inverse with motility. The rate of apoptosis determined by TUNEL technique in the study population was 30.46%. There was no correlation between apoptosis parameters and necrozoospermy and there was no correlation between sperm cell apoptosis and NO levels. Conclutions: Bacteriologic cure in seminal infection is higher with a scheme of 56 days than 28 days. Treatment with levofloxacin improves seminal parameters in infertile patients with spermatic tract infection. Nitric oxide but not TUNEL is a good predictive factor of antibiotic efficacy.

Extra-renal manifestations of autosomal dominant polycystic kidney disease (ADPKD) have been known to involve male reproductive organs, including cysts in testis, epididymis, seminal vesicles, and prostate. The reported prevalence of seminal vesicle cysts in patients with ADPKD varies widely, from 6% by computed tomography (CT) to 21%–60% by transrectal ultrasonography. However, seminal vesicles in ADPKD that are dilated, with a diameter greater than 10 mm by magnetic resonance imaging (MRI), are “megavesicles”. This is a separate entity from seminal vesicle cysts and has a prevalence of 23% in ADPKD patients, but is not known to occur in patients without ADPKD. The basis of these cystic changes and megavesicles has not been established, but may be explained by an imbalance between cell growth/proliferation inhibitors and stimulators analogous to mechanisms in renal tubular epithelial cells, hepatic ducts, and in the vasculature. Male infertility has been associated with ADPKD, although a causal role of seminal tract abnormalities has not been established. In this chapter, the anatomic abnormalities of seminal vesicles in ADPKD and their clinical significance will be discussed.

To investigate a new method and its effect on the procedure of dilating the ejaculatory duct and flushing the seminal vesicle with an F9 seminal vesicle scope in patients with chronic and recurrent seminal vesiculitis.Twenty-six patients with a diagnosis based to signs, laboratory detection, digital rectal examination, and transrectal ultrasonography were involved in present study. The patients underwent a surgical procedure of dilating the ejaculatory duct and flushing the seminal vesicles with an F9 seminal vesicle endoscope. All patients were followed for 3 months to 1 year after treatment.There were significant reductions in symptoms, signs, white blood cell and red blood cell counts on microscopic examination, seminal vesicles size, improvement of inner walls echo in transrectal ultrasonography, and semen culture positive rate. Moreover, all patients showed improvement.The present study provides a new transurethral seminal tract endoscopic technique with seminal vesicle scope through the normal anatomic tract to treat patients with chronic seminal vesiculitis. It proved to be easily conducted with minimized complications. Further investigations are needed to confirm our results.

In order to elucidate the locus and means of spermiophagy in passerine birds, we examined histologically the entire male reproductive tract of sexually mature birds of three passerine species with different forms of sperm competition, namely, the alpine accentor (Prunella collaris), the redflanked bush robin (Tarsiger cyanurus), and the Bengalese finch (Lonchura striata var. domestica). Spermiophagy occurred consistently and frequently in the epithelial layer of the seminal glomera and ejaculatory duct in each species, which were regularly identified by non-ciliated epithelial cells. The epithelial spermiophagy was occasional or infrequent in other portions of the seminal tract, and spermiophagy by macrophages was uncommon throughout the tract. Quantitative data in the seminal glomera and ejaculatory duct gave no clear answer concerning a possible relationship between the epithelial spermiophagy and different levels of sperm competition among these passerine species. In conclusion, the epithelial lining of the terminal region of the seminal tract is the main site for spermiophagy in the male reproductive tract of these passerine species, which activity serves to maintain the quality of semen by eliminating infertile spermatozoa as well as sperm remaining at the end of the breeding season.

Summary Male accessory gland infection (MAGI) has been identified among those diagnostic categories which have a negative impact on the reproductive function and fertility in males (Rowe et al., World Health Organization Manual for the Standardised Investigation and Diagnosis of the Infertile Couple, Cambridge University Press, Cambridge, 1993). MAGI is a hypernym which groups the following different clinical categories: prostatitis, prostate-vesiculitis and prostate-vesiculo-epididymitis. Some of the characteristics they share are: common diseases, mainly have a chronic course, rarely cause obstruction of the seminal pathways, can have an unpredictable intracanicular spread to one or more sexual accessory glands of the reproductive tract, as well as to one or both sides. In this review, we show that all components involving the inflammatory response (from the agents which first trigger it to each component of the inflammatory response dynamic) can deteriorate conventional and/or non-conventional sperm parameters arising from one or more of the following mechanisms: altered secretory function of the epididymis, seminal vesicles, and prostate which reduce the antioxidant properties or scavenging role of the seminal plasma; deterioration of spermatogenesis; and (unilateral or bilateral) organic or functional sub-obstruction of the seminal tract.

Anatomical (congenital or postinflammatory) or functional anomalies of the uroseminal intersection can induce a voiding dysfunction of the deferential ampullae and seminal vesicles, leading to infertility. In case of azoospermia or OAT-syndrome with poor semen volume and decreased vesicular markers, some clinical history and examination data can cause suspect of one of such anomalies. The transrectal ultrasonographic findings of anechoic area(s) inside the prostate and/or seminal vesicle (even after recent ejaculation), the peculiar vasovesiculographic pictures (especially after ejaculation following the contrast medium injection into the vasa deferentia), plus the evaluation of the "deferential-ampullary sperm reserve", will permit a detailed diagnosis of the voiding dysfunction of the uroseminal crossing. A successful appropriate treatment of these pathologies can be done. Ultrasonically-guided transrectal puncture, or transurethral incision upstream of (or resection of) the ejaculatory duct orifices, or prolonged sexual abstinence, or artificial spermatocele of the vas deferens, or sperm recovering from urine for GIFT or IVF/ET after washing-out of the seminal tract by vas puncture are all methods, which can be selectively used depending on the individual case, to treat these forms of infertility. The authors present some paradigmatic clinical cases, and report that this pathology presumably occurs in up to 9% of non-selected infertile patient population.

We report a rare case of a left ejaculatory duct that allotropically protrudes towards or invades the left vesicle triangular area with its dead end. The patient simultaneously exhibited multiple congenital malformations of the homolateral urogenital system, such as absence of the left kidney, dysplasia and allotopia of the left seminal vesicle, absence of the left ureterostoma, separation between the left testis and the epididymis tail, and maldevelopment of the left testis. According to all clinical and laboratory evidence, the case represented a new syndrome, which we named Wuyang's syndrome. It involved a rare phenomenon in embryonic development; the dysplastic proximal vas precursor, having intruded into a common mesonephric duct and accidentally encroaching on the ureteric bud position, resulted in the absence or dysplasia of the homolateral urinary tract and ectopic invasion of the bladder by the homolateral seminal tract.

This article discusses MR imaging of the normal prostate and of disease conditions of the prostate including prostatitis, cystic lesions, amyloidosis, calculi, hematospermia, benign prostatic hyperplasia, and malignancy.

Vesiculodeferentography was used in the past to evaluate suspected cases of obstruction of the seminal ducts. Over the years, numerous attempts have been made to improve the technique used to perform this examination and to render it less invasive. Its use is currently indicated in selected cases, where it is combined with functional studies like seminal tract washout and followed by immediate interventions to correct the alterations revealed. Vesiculodeferentography includes collection of the contents of the seminal vesicles, which can later be used in vitro assisted fertilization procedures.SommarioLa vesciculodeferentografia, esame utilizzato in passato nei casi di sospette ostruzioni delle vie seminali, è stato negli anni oggetto di numerosi studi allo scopo di migliorarne la tecnica di esecuzione e renderla meno invasiva. Attualmente è indicata solo in casi selezionati, in associazione a un'indagine funzionale quale il Seminal Tract Washout e prevedendo un contemporaneo – o in via subordinata, successivo – atto terapeutico.Ovviamente, peraltro, la procedura – ipso facto – prevede il prelievo di materiale dalla seminale e ciò può consentire una successiva procedura di fecondazione assistita in vitro.

The association between chronic inflammatory/infectious diseases of the male reproductive tract and the presence of antisperm antibodies (ASA) in semen is still controversial. We compared the results of the mixed agglutinin reaction (MAR) test and immunobead test for detecting ASA type IgG and IgA in 133 patients attending our special outpatient department for andrological infections and evaluated the differences in the detection rate of ASA. Patients were divided into three groups: a study group that included 79 patients with symptomatic nonacute inflammatory/infectious diseases of the seminal tract, a control group (n = 44) and a third group of men with a history of successful vasectomy reversal (n = 10). The two tests correlated in a statistically significant manner for the detection of IgG and IgA in all groups. The overall positive detection rate of clinical significant levels of IgG and IgA was 2.5% and 1.3% (respectively) in the patients with inflammation/infection of the seminal tract. No statistical significant difference in the detection rate of ASA levels between the inflammatory/infectious group and the controls was detected. The results of the MAR test and immunobead test have a statistical significant correlation and their results provide evidence that there is no association between inflammatory/infectious diseases of the male reproductive tract and the presence of ASA in semen.

To analyze the impact of commonly used drugs on male fertility, we assessed the clinical characteristics of patients with impaired semen quality while they were taking medication for chronic diseases and after switching therapies. Of 1768 infertile males, 201 patients were taking medications and had impaired semen quality without any seminal tract obstruction, spermatogenic abnormalities or hypogonadotropic hypogonadism. Of these 201 men, a total of 165 had no history of testicular diseases nor abnormalities in any examinations. Amongst them, H1 receptor antagonists were the most common medication taken, followed by antiepileptics and antibiotics. They were divided into two groups: an intervention group (73 patients), who could stop or switch their medications, and a control group (92 patients), who could not. In the intervention group, semen quality improvement rate and conception rate (93% and 85%, respectively) were much higher than those of the control group (12% and 10%, respectively). After switching therapies, the time interval before conception was 7.3 months, which was significantly shorter in asthenozoospermia than oligozoospermia. Our results confirm the potential fertility hazards of commonly used drugs and their reversibility. Moreover, after switching medication, drug-induced asthenozoospermia was cured more rapidly than oligozoospermia, suggesting that further delineation of such differences may help to elucidate mechanisms of spermatogenesis and might facilitate the development of non-hormonal male contraceptive agents.

Background and Aim We reviewed the findings of scrotal exploration, histological examination and clinical parameters in patients with clinically suspected idiopathic or inflammatory obstructive azoospermia without confirmation by isolated testis biopsy in advance.

This study presents a modified in vivo model in which the intraluminal pressures of the seminal vesicle and vas deferens can be measured simultaneously. Male Sprague-Dawley rats were grouped based on agent administered: serotonin, clomipramine, fluoxetine, sertraline, paroxetine, prazosin, terazosin, and tamsulosin. The control responses to hypogastric nerve stimulation (HNS) were recorded in each animal, and HNS was repeated after each drug administration. Serotonergic agents resulted in concentration-dependent inhibition of the HNS-induced seminal vesicle pressure increases (clomipramine>serotonin>fluoxetine>sertraline approximately paroxetine). On the other hand, only serotonin and clomipramine significantly inhibited vasal pressure responses. alpha-Adrenergic blockers inhibited both intraluminal pressure responses in a concentration-dependent manner. This model illustrates the importance of the hypogastric nerve for the stimulation of the seminal tract, with attention focused on the seminal vesicle. This model may be useful for the evaluation of drugs for the treatment of premature ejaculation.

The presence of interleukins (IL) and other cytokines in seminal plasma was demonstrated in the literature. In particular, the levels of IL-6 were found to be related to male accessory gland inflammation. The close correlation to leucocyte count indicates a production of interleukins from the leucocytes and by the prostate gland. No relation of IL-6 levels to spermatogenic activity was quoted in the literature. We measured IL-6 and IL-8 in 454 men and compared the values with seminal parameters. The mean values of IL-6 30.7 +/- 101.2 pg ml-1 and IL-8 2023 +/- 1721 pg ml-1. The correlation analysis revealed a significant correlation of IL-6 and/or IL-8 to age, total fructose, immunoglobulin G (IgG) concentration and leucocyte count. The significant correlation of IL-6 and fructose levels indicates that also the seminal vesicles take part in the production of seminal IL-6. No correlation of the two interleukins measured to sperm parameters occurred. The calculation of a single harmonic trend revealed a significant trend over the year of the levels of IL-6 with a maximum in December and a peak-to-trough variation of 33% of the mean. It may be the consequence of a higher frequency of seminal tract inflammations in autumn and winter.

Transrectal ultrasound (US) is the most commonly used imaging tool in the evaluation of the prostate. This article provides a synopsis of the normal and abnormal transrectal US findings of the prostate. The changes in normal transrectal US findings with aging are described, with simplified illustrations. The transrectal US findings of each disease of the prostate are also described. The clues, radiologic or combined with serology, which are helpful for differentiating between common prostatic diseases are also discussed. The seminal tracts are similarly discussed, with an emphasis on male infertility.

Microsurgical repair of obstructive male infertility is a challenge for the physician, but successful treatment depends on the experience and skills of the surgeon. Fertility can often be restored, thus avoiding the need for artificial reproductive techniques. The surgical procedures can be combined with sperm aspiration and cryopreservation, to be used for intracytoplasmic sperm injection in cases of surgical failure. In this review we will discuss the results of microsurgical procedures for obstructive male infertility, with special emphasis on technical refinements and prognostic indicators. Recently, surgical refinements, such as the invagination technique, have been introduced for the vasoepididymostomy procedure, showing promising first results. This simplified technique enables less experienced microsurgeons to perform this difficult operation successfully. The procedure is indicated for men with primary infertility and epididymal obstruction and for vasectomized men with secondary epididymal obstruction due to leakage of semen from the dilated epididymal tubule with subsequent fibrosis. This can be found in men with a long obstructive interval between vasectomy and reversal. In men with obstruction of the seminal tract, patency is found in 70-90% after microsurgical repair. In primary infertility and epididymal obstruction, other anatomical abnormalities of the reproductive tract can be found in nearly half of them, like obstructions of the ejaculatory ducts. In men with extreme oligozoospermia, by normal physical examination and normal hormonal evaluation partial obstructions of the seminal tract can be found in 50-60% of them. Vasectomy reversal is still the treatment of choice for secondary infertility after previous vasectomy. Although patency remains high, even after a long obstructive interval, the number of spontaneous pregnancies progressively decreases after a period of 10 years, due to loss of epididymal function and sperm motility. The main predictive factors for a successful outcome are the obstructive interval and the age of the female partner. Late stenosis after initial successful operation occurs in 12-18%. Repeat reversal procedures show a patency rate of 64-79%, and pregnancies are reported in 27-31%. Microsurgical reconstruction of obstructive male infertility can be a very rewarding procedure for both the infertile couple and the physician. Practical teaching courses are very helpful, and a learning curve should be taken into account. Urologists with an interest in male infertility should be encouraged to learn microsurgery as a part of their surgical training. The operations are best performed in centres for reproductive medicine, allowing different options to be available.

Spontaneous reconstruction of the sympathetic pathway projecting to the seminal tract after serious injury has not been well understood. Multiple cross-innervation mechanisms from the spinal cord via the hypogastric nerve to the seminal tract have been demonstrated currently. This study was undertaken to explore long-term spontaneous reconstruction of the canine hypogastric nerve (HGN), which controls ejaculation, after removing half of its length. Further, the study tried to identify the crossed-pathway(s) reconstructed. Responses of the vas deferens/epididymis and bladder neck to electrical stimulation of the lumbar splanchnic nerve (LSN) or the HGN were examined. In six dogs whose hypogastric nerve was injured bilaterally as described above 4 years before, corresponding to more than 20 years in human, nine (43%) and 13 (57%) of the 21 LSNs stimulated elicited elevation of vasal and bladder neck pressure, respectively. By combining re-transection of a HGN, the following pathways to the vas deferens/epididymis were identified to have been reconstructed: (1) to the ipsilateral vas deferens/epididymis without crossing to the other side; (2) to the contralateral vas deferens/epididymis by crossing to the other side at the caudal mesenteric plexus (CMP); (3) to the contralateral vas deferens/epididymis by crossing to the other side from the ipsilateral HGN at the commissural branches between the right and left pelvic plexuses (CBPP); and (4) to the ipsilateral vas deferens/epididymis by crossing twice at the CMP to the other side and at the CBPP again from the contralateral HGN to the ipsilateral side. The similar patterns of reconstruction were also observed in the bladder neck. The above results indicate that the sympathetic pathways via the HGN to the canine seminal tract can be reconstructed spontaneously in a high rate over a long period after serious injuries and that their cross-innervation system can be repaired.

Purpose: A pediatric case of ectopic vas deferens opening into the ipsilateral ureter is reported. Methods/Results: Ectopic opening of the vas deferens was detected incidentally at ureterocystoneostomy being performed for vesicoureteral reflux to the solitary kidney of a 7-month-old boy with anorectal anomaly. Conclusions: The preservation of the patency of the seminal tract is recommended.

Recent technical advances in microscopy have greatly improved the reconstruction of the seminal tract in cases of obstructive azoospermia. The authors evaluated the clinical outcome of 28 patients with obstructive azoospermia who underwent microsurgical reconstruction (i.e. vasovasostomy or unilateral epididymovasostomy). Diagnoses included post-vasectomy cases (n = 9) childhood inguinal herniorrhaphy (n = 10) and cases of unknown cause (n = 9). 6 of the unknown cases proved to be inoperable. The authors analyzed the outcome of the surgical reconstructions of operable cases according to the causes of obstruction duration of obstruction quality of the fluid obtained from the distal seminal tract (concentration morphology and motility of sperm) and the histologic findings of the testis. The surgical outcome was analyzed with regard to the incidence of patency and pregnancy. The incidence of patency achieved in nine vasectomy cases was 89% while the incidence of pregnancy was 44%. In contrast the incidence of patency in the 9 operable cases with herniorrhaphy was 44% while the pregnancy rate was 0%. Of 4 cases of unknown cause who underwent epididymovasostomy the incidence of patency was 100% and the incidence of pregnancy was 75%. The outcomes were worse in post-vasectomy cases with long-term obstruction of more than 10 years; however this was not statistically significant. The outcome was significantly worse in cases with low sperm concentrations. There was no significant relationship between histologic findings and surgical outcome. The surgical outcome of vasovasostomy of post-herniorrhaphy cases was significantly worse than that of post-vasectomy cases. With regard to epididymovasostomy a unilateral repair was clinically evaluated. (authors)

It has been suggested that prepubertal obstruction of the seminal tract may result in irreversible damage to spermatogenesis. We examined whether accelerated apoptosis in prepubertal obstruction has a deleterious effect on spermatogenesis in adulthood.We studied apoptotic changes of both prepubertal and adult obstructive azoospermia rat models by means of an in situ end-labeling technique and electron microscopy, and by examination of the pathological changes. Four groups were designed as follows. Group 1: bilateral vasectomies performed at ten days of age (prepubertal vasectomy model); Group 2: sham operation performed at ten days of age; Group 3: bilateral vasectomies performed at eight weeks of age (adult vasectomy model); Group 4: sham operation performed at eight weeks of age. Three rats in each group were killed weekly, and the testes and epididymides removed and weighed. Germ cell apoptosis was detected by in situ end-labeling, and the apoptotic index (AI) was calculated by dividing the number of in situ labeled cells by the total number of seminiferous tubules. The developmental change of testis and epididymis, the diameter of seminiferous tubules, and the number of spermatogonia were also examined. Histopathological examination of tubular diameter and the number of spermatogonia and Sertoli cells was done by PAS staining. The number of spermatogonia divided by the number of Sertoli cells per tubular cross section was expressed as spermatogonia-Sertoli cell ratio (S-S ratio).At 3 and 4 weeks of age, rats of group 1 demonstrated a significantly higher apoptotic index of germ cells than did the sham-operated rats of group 2 (p0.05). No significant differences were seen between groups 3 and 4. The increased apoptosis in group 1 seemed to be reduced by the formation of epididymal granulomas. The tubular diameter of group 1 at 16 weeks of age was significantly smaller than that of groups 2, 3, or 4. The S-S ratios were lower at stages IV, V and VI in group 1 at 16 weeks-of-age following vasectomy at 10 days of age compared with that in group 2.We conclude that an increase of apoptotic degeneration of germ cells in the prepubertal period may cause irreversible changes in germinal stem cells, resulting in hypospermatogenesis in adulthood.

Childhood inguinal herniorrhaphy is a frequent causes of seminal tract obstruction. We investigate the characteristics of this obstruction, surgical techniques for reanastomosis and outcomes in patients with bilateral or unilateral obstruction caused by inguinal herniorrhaphy in childhood.We treated 22 men an average of 30.5 years old in whom average duration of obstruction was 27.1 years. Obstruction was bilateral in 9 patients and unilateral in 13, and 14 had azoospermia preoperatively. Microsurgical 2 layer vasovasostomy and/or specific tubule epididymovasostomy was performed.Inguinal and crossed vasovasostomy was done in 18 and 4 patients, respectively. The distal end of the vas was found at the internal inguinal ring or in the pelvic cavity in 57.1% of the vasa and more than 3 cm. of the vas had been resected in 37%. Sperm was noted in vasal fluid in 45.2% of the vasa during the operation and the patency rate of inguinal vasovasostomy was 88.9%. Ipsilateral epididymovasostomy performed after patent inguinal vasovasostomy in 5 patients with secondary epididymal obstruction resulted in normal sperm density and 3 pregnancies. In 7 men more than 2 procedures were done. There was sperm in the ejaculate in 12 of the 14 patients who had had azoospermia preoperatively and apparently increased sperm density postoperatively in 4 of the 8 who had not had azoospermia preoperatively. Pregnancy was achieved by 7 of the 21 married men (33.3%).Microsurgical reanastomosis of the seminal tract resulted in high patency and pregnancy rates in cases of seminal tract obstruction caused by childhood inguinal herniorrhaphy. Patients should elect seminal tract reanastomosis or assisted reproductive technology using epididymal or testicular sperm after receiving sufficient information on each treatment modality.

To explore the peripheral signal controlling ejaculatory reactions, contraction of the seminal tract and seminal emission were monitored in the dog during electrical stimulation of the lumbar and greater splanchinc nerves in the presence or absence of sympathetic pathways connecting the lumbar sympathetic trunk to the seminal tract including the vas deferens, prostate and bladder neck. Electrical stimulation of the lumbar splanchnic nerve caused seminal emission, elevation of intraluminal pressure of the vas deferens and bladder neck, and contraction of the prostate without elevation of blood pressure. Transection of all peripheral sympathetic nerve pathways to the seminal tract completely blocked these responses. Electrical stimulation of the greater splanchnic nerve caused a marked elevation of blood pressure as well as the responses described above in both the presence and absence of peripheral sympathetic nerve pathways to the seminal tract. However, clamping the adrenal veins bilaterally blocked all of the above responses and declamping immediately reversed the block. Serum levels of epinephrine, norepinephrine and dopamine were significantly increased by electrical stimulation of the greater splanchnic nerve, while cortisol levels remained unchanged. Furthermore, intravenous administration of epinephrine (5 micrograms/kg) caused responses similar to those elicited by stimulating the greater splanchnic nerve. Dogs in which all sympathetic pathways to the seminal tract had been transected chronically showed retrograde ejaculation during manual penile stimulation. The above results indicate possible involvement of the greater splanchnic nerve and adrenal medulla in ejaculatory reactions in the dog.

The purpose of this study was to define the abnormal findings of the prostate and seminal tract on magnetic resonance (MR) imaging by using an endorectal coil in patients with suspected obstructive infertility. MR imaging of the seminal tract with an endorectal surface coil was performed on 20 consecutive patients who were suspected of having obstructive infertility. Diffuse atrophy of the seminal vesicles (SVs) was seen in eight patients (40%) and was the most prevalent abnormal finding. It was most often associated with an irregular thickening of the vasa deferentia and small prostate (n = 4; 20%). Other abnormal findings were two mullerian duct cysts; and four cases of the aplasia of SV and vasa deferentia, three of which were associated with rudimentary mesonephric duct. MR imaging of the seminal tract with an endorectal surface coil can clearly demonstrate the various abnormalities of the seminal tract in obstructive infertility.

Purpose: We evaluated the prostate and seminal tract with magnetic resonance imaging (MRI) in patients with hemospermia.Materials and Methods: To evaluate the prostate and seminal tract in 17 patients 20 to 59 years old (mean age 44) with hemospermia we performed transrectal ultrasound and MRI using an endorectal surface coil with a 1.5 tesla unit. Mean duration of hemospermia was 32 months (1 week to 16 years).Results: Abnormalities were noted on transrectal ultrasound in 15 of the 17 patients (88%) and on MRI in all. Of the 12 cases of hemorrhage 10 involved the seminal vesicle and 2 involved the ejaculatory duct. There were 12 cystic lesions, including 7 in the mullerian and 5 in the ejaculatory ducts. Of 19 cases calculi were detected in the prostate in 5, seminal vesicle in 8, and ejaculatory and mullerian duct cysts in 4 and 2, respectively. There was 1 case of prostatic atrophy and 1 wolffian duct anomaly associated with an ejaculatory duct cyst, ectopic ureterocele and absence of the left ...

Objectives Evaluation of the presence of spermatozoa in vas deferens fluid after a long interval of unilateral and homolateral percutaneous epididymal sperm aspiration (PESA) in vasectomized men. When found, the spermatozoa were evaluated including concentration and motility, in order to verify the patency of the epididymal tubules. Materials and Methods Four patients, numbered in a progressive order, from one to four, with 38, 40, 48 and 51 years old and vasectomy interval of 10, 10, 25 and 11 years, respectively, whose wives did not get pregnant using intracytoplasmic sperm injection of sperm obtained by unilateral PESA and decided to try only natural conception, were submitted to intrasurgical sperm analysis of the vas deferens fluid (ISAVDF) during microsurgery for reconstruction of the seminal tract. Results Time interval between PESA and ISAVDF was 13.75 ± 11.12 months (x ± s) varying from 3 to 29 months. Homolateral ISAVDF and PESA showed the presence of spermatozoa. Patients 1, 2 and 4 had a high concentration of 10 x 106, 64 x 106 and 45 x 106 spermatozoa/ mL; the first two had motile sperms and patient 3 had no sperms. Conclusions Three of four patients showed spermatozoa in the vas deferens fluid after a long interval of unilateral and homolateral PESA with high concentration, including motile forms. These findings support the concept that PESA may not result in late epipidymal tubule obstruction in vasectomized patients.

Obstructive azoospermia is a relatively common male infertility condition. The main etiologies of obstructive azoospermia include congenital, surgical-derived, traumatic and post-infectious cases. Although seminal tract reconstruction is a cost-effective treatment in most cases, this approach may not be feasible or desired in some cases. In such cases, assisted reproduction techniques offer a method for achieving pregnancy, notably via sperm retrieval and intracytoplasmic sperm injection. This process requires several considerations and decisions to be made, including the cause and duration of obstruction, which sperm retrieval technique to use, and whether to use fresh or frozen-thawed sperm. We present a review of obstructive azoospermia and assisted reproduction techniques, highlighting the most relevant aspects of the decision-making process for use in clinical practice.

Intraluminal pressure of the seminal tract at seminal emission from the ejaculatory duct and the mode of transport of cauda epididymal contents were investigated to explore the mechanism of sperm transport. Direct electrical stimulation of any site of the cauda epididymis and vas deferens, which generated nerve-transmitted muscle contraction, caused elevation of the intraluminal pressure only at the cauda epididymis, whereas stimulation of the testis, caput, and corpus epididymis caused no response. The dye instilled in the cauda was emitted into the urethra during the stimulation. Shortly after discontinuation of the stimulation, retrograde movement of residual dye in the vas resulted in its ultimate reentry into the cauda epididymis. Significant decrease of the muscle tonus just after contraction was observed at the cauda. Distension of the wall of the vas generated elevation of the intraluminal pressure only at the site distended. The above results indicate the presence of rapid antegrade and retrograde movement of the sperm and the crucial role of the cauda epididymis on the sperm transport.

A case is presented of an ectopic ureter opening into the seminal vesicle associated with hypodysplastic kidney in an infant. We reviewed 135 cases (139 ureteral units) of male ectopic ureter from the Japanese literature and, of the 139 ectopic ureters, 109 were single-system ectopic ureters, and 26 ureters were associated with the ureteral duplication. Sixty-three and 73 ureters opened into the urinary tract and seminal tract, respectively. In patients 15 years or older, 65 cases of ectopic ureter opened into the seminal tract and 33 cases opened into the urinary tract, whereas in children under 15 years, the ectopic orifice was located more often in the urinary tract (26 cases) than in the seminal tract (8 cases). Presenting symptoms differed according to the location of the ectopic orifice. Ectopic ureters opening into the urinary tract most often presented with urinary tract infection and abdominal or lumbar pain. On the other hand, voiding and ejaculatory symptoms as well as perineal or genital pain were characteristic in ectopic ureters opening into the seminal tract. Of the 83 associated renal segments that were surgically removed, dysplasia, hypoplasia and aplasia were found in 22, 24, 14 cases, respectively. It was noteworthy that 48 of the 53 single ectopic ureters opening into the seminal vesicle were associated with ipsilateral renal dysgenesis.

Introduction Iatrogenic damage to the seminal tract is one of the causes of obstructive azoospermia, which can be an indication for reconstruction surgery. We present a case of obstructive azoospermia as an unusual complication after neonatal herniorrhaphy of an omphalocele. Case presentation A 30-year-old Japanese man was diagnosed with obstructive azoospermia. He had undergone herniorrhaphy of an omphalocele immediately after birth. Reconstruction surgery of both seminal tracts was performed to pursue the possibility of naturally achieved pregnancy. Intra-operative findings demonstrated that both vasa deferentia were interrupted at the internal inguinal rings, although the abdominal end of the right vas leading to the seminal vesicle was found in the abdominal cavity. The discharge from the stump of the testicular end had no sperm, although the right epididymal tubules were dilated with motile sperm. Therefore, we performed right-sided vasovasostomy in the internal inguinal ring and ipsilateral epididymovasostomy simultaneously. Conclusion To the best of our knowledge, this is the first report describing obstructive azoospermia as an unusual complication of herniorrhaphy of an omphalocele. It is important to pay attention to the existence of seminal tracts in such surgery as well as in inguinal herniorrhaphy.