Abstract：
Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.
摘要：
经尿道射精管切除术（TURED）是治疗射精管囊肿引起的射精管阻塞（EDO）的主要手术方法。通常需要术中切除精管以暴露射精管。然而,保留Verumontanum结构可以更好地模拟正常的生理解剖结构。维持verumontanum可能会增加术后远端射精管瘢痕的风险，导致反复梗阻或精液量减少。因此,我们尝试了一种新的技术来保存Verumontanum，与TURED相比相对更容易和更安全。以下是程序步骤:1.通过外尿道口将6F的精囊镜引入到Verumontanum附近，定位患侧射精管的开口，并将导丝引入囊肿。这个成功的步骤保存了Verumontanum，最大限度地保留在远端射精管中的抗反流机制。2.钬激光将患侧射精管开口扩大到5毫米，降低射精管开口术后闭合的可能性并简化手术。3.在囊肿内创建一个窗口以进入对侧精囊，然后使用钬激光将开口燃烧并扩张到5毫米，重新引导对侧射精管进入囊腔。这种修改保留了健康侧射精管的开口，并为精液提供了新的流出通道，降低术后精液体积减少的风险。患者术后无并发症,住院时间较短，并显示精液体积的改善。因此，这种手术方法简单但有效。
