Targeted resection
The seminal tubercle is a small elevation on the posterior wall of the prostatic urethra, into which the ejaculatory ducts and prostatic uterus open. When it becomes inflamed, hypertrophied or cystic, the path to sperm is blocked and urination is impaired. Using a resectoscope with a thin loop, the surgeon resects the altered tissue until the free flow of duct contents appears (in case of obstruction) and coagulates the vessels; the external sphincter, located nearby, is carefully protected. The tissue is examined histologically. The catheter lasts 1–2 days; Sexual activity is resumed after 2–3 weeks.
Indications for TUR of the spermatic tubercle
- hypertrophy of the seminal tubercle with difficulty urinating and pain in the perineum;
- obstruction of the ejaculatory ducts - small volume of ejaculate, lack of sperm (obstructive azoospermia);
- recurrent hemospermia (blood in semen) due to a cyst or inflammation of the tubercle;
- chronic colliculitis that is not amenable to conservative treatment;
- cysts of the Müllerian duct and prostatic uterus, opening into the tubercle.
Results
After resection, obstruction and pain during ejaculation disappear; with obstructive azoospermia, sperm appear in the ejaculate in 50–70% of men. Possible consequences are retrograde ejaculation and reflux of urine into the ejaculatory ducts, so the volume of resection is limited to the minimum necessary. Erection does not suffer.
