(224) ROBOTIC UNILATERAL SEMINAL VESICULECTOMY FOR CHRONIC HEMATOSPERMIA

Abstract Introduction Hematospermia is typically self-limited and warrants no surgical intervention. Chronic hematospermia however can be quite concerning and requires further investigation. We present here an unusual case of chronic hematospermia lasting 5 years in a 22-year-old patient. He had no other symptoms besides painless hematospermia which was present in every ejaculation. Patient had a PMH of depression and congenitally absent left kidney. Physical examination was within normal limits. STI/Urine testing, lab work, and scrotal ultrasound were all normal. Patient was treated with several antibiotic courses which were unsuccessful. After failing conservative medical management, he was successfully treated eventually by robotic unilateral seminal vesiculectomy in the absence of seminal vesicle cyst/tumor. Objective Describe a unique cause of chronic hematospermia characterized by blood pooling the left seminal vesicle in the absence of trauma, infection, tumors, and cysts. We also describe a technique in using robotic unilateral seminal vesiculectomy as a form of successful treatment. Methods In order to lateralize which SV was causing hematospermia, a pelvic MRI was obtained which revealed a pooling of blood in the left SV with no cysts nor tumors noted. After being counseled on the risks of surgery including erectile and ejaculatory dysfunction, the patient agreed to undergo surgical removal of the left SV. In the OR, the patient was placed supine with 30 degrees of Trendelenburg. The bowels were mobilized cranially and the DaVinci robotic arms were used to mobilize the left SV. The base of the SV duct was ligated with suture and subsequently transected. Bipolar cautery and hemostatic agents were used to achieve hemostasis. Results Patient stayed one night in the hospital before being discharged. He re-presented on POD#3 with abdominal pain and was found on CT scan to have a pelvic hematoma which was evacuated via robotic assisted laparoscopic approach. Patient was discharged the next day without further issue. At 6 months follow up, the patient had no symptoms. His hematospernia completely resolved. He had adequate erections with good ejaculate force and volume. Pathology of the left SV revealed chronic inflammation and vascular congestion. Conclusions Robotic-assisted laparoscopic unilateral seminal vesiculectomy is a viable treatment option of chronic hematospermia when the etiology of hematospermia can be lateralized to one SV. To our knowledge, this appears to be the first ever case of seminal vesiculectoy for a reason other than SV cyst or SV tumor. Erection and ejaculatory potency are risks of seminal vesiculectomy but these risks can be mitigated with good surgical technique. We suggest that the risk of post-operative pelvic hematoma from seminal vesiculectomy is not higher than that of any other pelvic surgery. Disclosure No.