Seminal vesiculoscopy for refractory hematospermia

Purpose: To describe a reproducible transurethral seminal vesiculoscopy (TUSV) technique for managing refractory hematospermia and to share outcomes along with approach-selection considerations.Surgical Methods: A 37-year-old man with a 6-month history of persistent hematospermia underwent TUSV following transrectal ultrasound/magnetic resonance imaging localization.The video demonstrates a trans-utricle seminal vesiculoscopy.After entering the prostatic utricle by advancing through the verumontanum, a yellowish utricular stone was identified.To evaluate the seminal vesicle, the guidewire was advanced from the utricle to the utricle-seminal vesicle junction, where a limited trans-utricle fenestration was created to allow entry and inspection of the vesicular lumen.Results: During this uneventful procedure, stone and organized material were completely cleared, the typical honeycomb mucosa of the seminal vesicle was confirmed, and no additional pathology was detected.The patient was discharged after early catheter removal, and complete resolution of hematospermia without ejaculatory or urinary dysfunction was reported 1 month later.Conclusions: TUSV is an effective procedure for intractable hematospermia when conservative therapy fails and imaging localizes tract-level pathology.