摘要This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia.A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center,prospective,observational study.The median follow-up period was 36.5 (range: 8.0-97.5) months.TSV was successfully performed in 272 (96.8％) patients.The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum.Seven (2.6％),74 (27.2％),64 (23.5％),and 127 (46.7％) patients had Types Ⅰ (through the ejaculatory duct in the urethra),Ⅱ (through the ejaculatory duct in the prostatic utricle),Ⅲ (transutricular fenestration through a thin membrane),and Ⅳ (real-time transrectal ultrasound-guided transutricular fenestration) approach,respectively.In patients who successfully underwent surgery,bleeding occurred in the seminal vesicle in 249 (91.5％) patients.Seminal vesiculitis,calculus in the prostatic utricle,calculus in the ejaculatory duct,calculus in the seminal vesicle,prostatic utricle cysts,and seminal vesicle cysts were observed in 213 (78.3％),96 (35.3％),22 (8.1％),81 (29.8％),25 (9.2％),and 11 (4.0％) patients,respectively.Hematospermia was alleviated or disappeared in 244 (89.7％) patients 12 months after surgery.Fifteen patients had recurrent hematospermia,and the median time to recurrence was 7.5 (range: 2.0-18.5) months.TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.