Background: The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance. Methods: Twenty-one patients aged 26-75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS).Results: Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient. Conclusion: Puncture of the seminal vesicles and/or müllerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.

OBJECTIVES To reclassify midline cysts (MLCs) of the prostate according using the results from transrectal ultrasonography (TRUS)‐guided opacification and dye injection. PATIENTS AND METHODS Eighty‐six patients (mean age 60.9 years) who had MLCs detected in the pelvis by TRUS were investigated. In all patients the size of the MLC was measured and they had transperineal aspiration under TRUS guidance. After aspiration of the MLC a mixture of water‐soluble contrast medium and indigo carmine dye was injected to check for communication with the urethra or seminal tract by endoscopic and pelvic X‐ray examination. RESULTS We classified MLCs into four categories: (i) type 1 (nine cases), MLC with no communication into the urethra (traditional prostatic utricle cyst); (ii) type 2a (60 cases), MLC with communication into the urethra (cystic dilatation of the prostatic utricle, CDU); (iii) type 2b (14 cases), CDU which communicated with the seminal tract; (iv) type 3 (three cases), cystic dilation of the ejaculatory duct. The location, shape and volume of the MLC, and the prostate‐specific antigen level of MLC fluid, did not influence the classification. CONCLUSIONS The most common type of MLC was CDU. A new classification that depends on the communication with the urethra or seminal tract is proposed.

We studied the effect and the indication of various kinds of surgical treatment for central (thalamic) pain in 10 cases. In 3 cases with localized pain, epidural spinal cord stimulation was effective. In 7 cases with diffuse pain (hemibody), stereotactic Vim-Vcpc thalamotomy was performed with the aid of depth microrecording. In 4 of these cases in which pain relief was obtained, we could find responses to peripheral natural stimulation on the sensory thalamus during the operation. Preoperative PET study also revealed an increase of rCBF on the sensory cortex ipsilateral to the thalamic CVD lesion during contralateral thumb brushing. On the other hand, in the 3 cases in which we failed to obtain pain relief, we frequently encountered irregular burst discharges on the thalamus. Gamma thalamotomy was added after the conventional thalamotomy in these 3 cases. Though transient pain relief was obtained, pain recurred thereafter. Precentral electrical cortical stimulation was also carried out in 3 recurrent cases, resulting in the failure of pain relief. In one of these cases, internal capsular (posterior limb) stimulation was performed, obtaining encouraging result. In cases of localized thalamic pain, epidural spinal cord stimulation proved to be an effective treatment. Thalamic surgery achieved pain relief in those cases with diffuse type pain, limited to preserving sensory function on the sensory thalamocortical system. Precentral electrical cortical stimulation, internal capsular (posterior limb) stimulation or Gamma thalamotomy may be an alternative treatment for central (thalamic) pain.

Objective: To determine whether urethritis is accompanied by seminal vesiculitis using transrectal ultrasound (TRUS) imaging. Methods: Fifty-six male patients (mean age 31.6 Ϯ 8.7 years) with urethritis were included in the study. As a control group, we also considered 34 healthy volunteers (mean age 21.3 Ϯ 1.8 years). The two groups were evaluated by the nucleic acid amplification test and imaging studies using TRUS. Results: The nucleic acid amplification test could identify 15 patients (26.8%) with gonococcal urethritis (five had accompanying chlamydial urethritis), 32 (57.1%) with chlamydial urethritis, and nine (16.1%) with nongonococcal and nonchlamydial urethritis. The mean anteroposterior diameter of the bilateral seminal vesicles was significantly longer in the urethritis group than in the controls (12.9 Ϯ 3.3 mm vs 11.0 Ϯ 2.0 mm, P = 0.004). The incidence of dilatation or cystic changes of seminal vesicles was significantly higher in the urethritis group than in the controls (dilatation: 30% vs 9%, P = 0.019; cystic change: 39% vs 12%, P = 0.007). There was no significant difference in the incidence of dilatation or cystic changes of seminal vesicles between gonococcal urethritis and chlamydial urethritis. Conclusions: Patients with urethritis are likely to have accompanying seminal vesiculitis. This suggests a close interrelationship among urethritis, seminal vesiculitis and epididymitis.

We studied the effectiveness of electrical stimulation treatment in 10 cases with central (thalamic) pain. Pain was caused by thalamic hemorrhage in 6 cases. There was one case each of putaminothalamic, putaminal, pontine hemorrhage and thalamic infarct. We were able to achieve sufficient and long-term pain control by epidural spinal cord stimulation in all 4 cases in which pain was localized on the distal part of the upper or lower extremity. Pain control extended for a mean of 3.8 years in these cases. Precentral cortical stimulation treatment was carried out in 6 cases with diffuse pain (hemibody). Three cases were new, while 3 others were recurrent cases after thalamotomy. Sufficient pain relief was achieved in 3 cases. However, it was not obtained in the other 3 cases. In the former 3 cases, two were new with one recurrent case after thalamotomy. Pain was controlled during a mean of one year and 9 months. In all these cases, spontaneous pain was severe but hypesthesia mild. Electrical stimulation on the presumed precentral cortical area evoked a sensori-motor effect on the painful part of the body with low voltage stimulation. Regional CBF or rCMRglu decreased slightly and was localized in the affected thalamus. A MEG study demonstrated preservation of spino-thalamo-cortical function in one case. In the latter 3 cases in which we failed to obtain pain relief, one was new and the other two were recurrent cases after thalamotomy. In the 2 recurrent cases, we frequently encountered irregular burst discharges and positive spikes, but seldom found sensory responses of the sensory thalamus to peripheral natural stimulation during the operation. In one of these 3 cases, internal capsular (posterior limb) stimulation was performed, resulting in sufficient but short-term pain relief. In cases of localized thalamic pain, epidural spinal cord stimulation proved to be an effective treatment. In cases with diffuse pain, precentral cortical stimulation could be expected to ameliorate the intractable pain in those limited cases in which CVD had caused mild destruction of the pain conducting system and the spino-thalamo-cortical function was mostly preserved.