Patient Zhang, male, 36 years old, repeated intermittent hematospermia for 10 years, aggravated with persistent hematospermia for 1 year. The cystourethroscope was successfully placed into the bladder under direct visualization, and the whole bladder was observed routinely, and then the mirror was retreated to the plane of the seminal mound, which showed that the seminal mound was obviously elevated and enlarged, and the opening of the prostatic vesicle at the top was clearly visible. Bilateral ejaculatory duct openings are sought and determined based on the location of the prostatic vesicle openings, at which point the localization and patency of the ejaculatory duct openings are determined in conjunction with intra-anal vesicle massage. Usually, the bilateral ejaculatory duct openings are located slightly distal to the top of the seminal vesicles, at 4 or 8 o’clock, forming an equilateral triangle or isosceles triangle with the opening of the prostatic vesicles. Repeated massage of the right seminal vesicle did not show any spilling of seminal vesicle fluid at the opening of the right ejaculatory duct; then repeated massage of the left seminal vesicle did not show any spilling of seminal vesicle fluid at the opening of the left ejaculatory duct, indicating that there was obvious obstruction of the opening of the ejaculatory ducts bilaterally. Next, the prostatic vesicles in the midline region were massaged, which showed that there was obvious bloody fluid overflow from the opening of the prostatic vesicles, indicating that the bleeding came from the prostatic vesicles, or the ejaculatory ducts opened in the prostatic vesicles, and that the bleeding in the seminal vesicles was overflowed from the opening of the vesicles. After repeated rinsing, the right ejaculatory duct was found to open at the 8 o’clock position behind the side of the prostatic vesicle, and the vesicoscope could directly enter the seminal vesicle through this ejaculatory duct opening, and the seminal vesicle was found to have an obvious fresh blood clot and scattered diffuse congestion. By applying the perfusion pump to flush with appropriate pressure and repeatedly entering and exiting the vesicoscope, the purpose of thorough flushing of the seminal vesicles and effective expansion of the opening of the ejaculatory duct was achieved. After rinsing the right seminal vesicle, the left ejaculatory duct opening was observed, which showed that the left ejaculatory duct opening was located in the small capsule at the symmetrical part of the right ejaculatory duct opening at the 4 o’clock position. The same method was applied to the left seminal vesicle to observe the left seminal vesicle, and it was found that there was obvious blood clot and diffuse congestion in the left seminal vesicle, and the opening of the left ejaculatory duct was dilated by repeated rinsing. Repeated irrigation and dilation of the left ejaculatory duct opening was performed. After changing the urethral cystoscope, the opening of the vesicles was observed and judged with vesicourethral massage, which showed that the opening of the vesicles was wide and smooth, and repeated vesicourethral massage did not cause any bloody fluid overflow. Postoperative urinary catheter was routinely left in place for 1-3 days.