The diagnostic value of TRUS guided needle puncture on seminal vesicle diseases

摘要

To evaluate the diagnostic value of transrectal ultrasonography (TRUS) guided transperineal needle puncture on seminal vesicle (SV) diseases.Methods This series included 28 patients (mean age,38 years) with hematospermia and dysuria.Their mean disease course was 15.8 months.TRUS and TRUS guided aspiration were used to evaluate patients with abnormality found by ultrasonography.The patients underwent TRUS guided transperineal puncture for SV or cysts.The seminal vesicle fluid (SVF) was aspirated and sent for bacteriological culture and cytological assay.Imaging contrast was injected into the SV or cysts for X-ray examination.All the patients were followed up for 1 month after puncture;then repeated puncture was done.For solid lesion,biopsy was performed for pathologic examination.Results The abnormal findings of TRUS included;20 cases with SV and/or ejaculatory duct dilation,5 cases with SV cyst,3 cases with SV carcinoma.Other findings included;thickening of the SV wall (6 cases),calcification (3 cases) or calculi (1 case) of the SV.All the bloody fluid was aspirated from the dilated SV or cyst,including 17 cases (19 lesions) of SV dilation,3 cases of ejaculatory duct dilation and 5 cases of SV cyst.Bacteria in SVF or cyst fluid were found in 17 cases,and antibiotics-resistant bacteria in 10 of the 17 cases.There was no complication of the puncture except for mild hematuria in 7 cases,and it disappeared within 3 days.Twenty-six cases were followed up for 6-36 months.Repeat puncture with antibiotics perfusion was done in 19 cases; the hematospermia disappeared in 6 cases and 3 cases after puncture was done once and twice,respectively.However,10 cases still had persistent hematospermia after 3 times of puncture.Conclusion The morphological changes of SV can be directly observed by TRUS,and the “pure” SVF,cyst fluid or biopsy tissue can be obtained.And subsequent bacteriologic,cytologic histopathologic methods and imaging examination can help make the diagnosis.TRUS guided transperineal injection of antibiotics into SV may also have great value in treatment of refractory hematospermia.8 refs.