Endoscopic Treatment for Persistent Hematospermia: A Novel Technique Using a Holmium Laser

Purpose: We present our endoscopic technique for treating ejaculatory duct and seminal vesicle diseases with a holmium laser. Materials and methods: Fifteen patients with persistent hematospermia were enrolled in this study from June 2007 to April 2014. All patients had failed medical treatments. All patients were evaluated with transrectal ultrasound and pelvic computed tomography or magnetic resonance imaging. We performed endoscopic treatment with a semi-rigid ureteroscope after dilation using a guidewire and ureteral serial dilator. A holmium laser was used to incise the obstructed ejaculatory duct, coagulate hemorrhagic mucosa, and fragment stones in the ejaculatory duct or seminal vesicles. Stones were removed using a basket and forceps. Results: The mean duration of hematospermia was 30.6months. Mean patient age was 45.3years. The mean serum levels of prostate-specific antigen and testosterone were 1.36 and 4.95ng/mL, respectively. No operative complications were encountered. Mean operative time was 35.4min. Seven patients had ejaculatory duct or seminal vesicle stones, which were subsequently determined to be carbonate apatite, mucin, struvite, and calcium oxalate dehydrate stones. Mean duration of follow-up was 32.1months. Although two patients showed recurrent hematospermia 11 and 12months after the operation, hematospermia resolved in 13 patients (86.7%). The infertile patient showed an improved semen finding and had a successful pregnancy. Conclusion: Endoscopic treatment using a holmium laser is minimally invasive and was effective for treating ejaculatory duct and seminal vesicle diseases, which are the main cause of hematospermia.