Transperitoneal Laparoscopic Unroofing versus Fenestration Under Seminal Vesiculoscopy for Seminal Vesicle Cyst, a Multi-Institutional Retrospective Cohort Study

Abstract

Ke Ding,1 Wei Wang,2 Ye Kang,3 Lei Zhang,2 Shuo Tan,1 Zhengyan Tang1 1The Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2The Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 3The Department of Urology, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Shuo Tan; Zhengyan Tang, Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan, 410008, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: To illustrate the transperitoneal laparoscopic unroofing (TLU) and compare the efficacy and safety of TLU to fenestration under seminal vesiculoscopy (FUSV) in treating symptomatic seminal vesicle cyst (SVC).Methods: We retrospectively reviewed all patients with symptomatic SVC who underwent TLU or FUSV between 2008 and 2020 at 3 institutions in Hunan. The two groups were evaluated with reference to radiological failure-free survival (R-FFS), fertility outcome, symptoms, and complications at a median 33.5-month follow-up.Results: Of the 98 males, 58 (59.2%) received TLU, and 40 (40.8%) underwent FUSV. Baseline characteristics were comparable. Semen analysis, prostatitis-like symptoms, and the maximum diameter of cyst were partially improved after both surgeries at 12-month follow-up. The TLU groups suggested a higher incidence rate of fertility for SVC patients with comorbid infertility compared with the FUSV group (82.4% vs 70.3%, p = 0.041), as well as better R-FFS of cysts at five-year follow-up (Log rank test, p = 0.021). In addition, the number of patients with NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) scores higher than 15 decreased more significantly after TLU (p = 0.004). Except for hematospermia within 3 months, no significant difference in adverse events was observed in the two groups during the long-term follow-up.Conclusion: TLU was superior for patients with large and symptomatic SVC to FUSV, with more relieved symptoms, better R-FFS of cysts and fertility outcomes.Registration Number of Clinical Trial: ChiCTR2100053850 in Chinese Clinical Trial Registry Platform (ChiCTR).Keywords: seminal vesicle cyst, laparoscopic unroofing, seminal vesiculoscopy, radiological failure-free survival, male infertility

Keywords

• seminal vesicle cyst
• laparoscopic unroofing
• seminal vesiculoscopy
• radiological failure-free survival
• male infertility.