Editorial Comment on: An Innovative Technique of Transurethral Seminal Vesiculoscopy with Ultrasonic Lithotripter for Severe Persistent Hematospermia by Zhang et al .

The authors have conducted a retrospective nonrandomized review of 30 patients with persistent hematospermia who underwent transurethral seminal vesiculoscopy (TSV). They compared the outcome of utilizing a 3.3F ultrasonic lithotripter vs a holmium laser during TSV. The decision to use lithotripters vs holmium laser was at the discretion of the surgeon. However, there is no difference in patient characteristics and preoperative imaging findings between the two groups.

The authors have demonstrated the feasibility of using an ultrasonic lithotripter during TSV. Compared with holmium laser, using the lithotripter was associated with shorter operative time. This can be attributed to the continuous suction property of the ultrasonic lithotripter, which leads to less change of instrumentation and better intravesicle vision. Despite the small sample size, the authors noted that patients who underwent TSV using ultrasonic lithotripter did not recur during the study follow-up.

The success rate in the lithotripter arm surpasses previously reported outcomes of 80% to 90% from other series. ^1,2 To rationalize this finding, removing debris and stone actively may interrupt the harsh cycle of chronic irritation and repeated hematospermia. The issue of success durability needs to be answered with longer follow-up.

In the current algorithm of treating persistent hematospermia, TSV is considered as a last resort option in management. In order for TSV to be embraced by the urologic community, it is important to standardize outcome measurement by reporting the changes in IPSS, NIH-CPSI, SHIM score, and semen analysis. This article highlights the need for further efforts to optimize TSV, as the authors did, with the use of an ultrasonic lithotripter, which herein strongly supports its use in the treatment of refractory hematospermia.