129 Endourological Management of the Obstruction of the Ejaculatory Ducts Due to a Midline Prostatic Cyst

Abstract

Obstruction of the ejaculatory ducts secondary to a midline prostatic cyst is an infrequent cause of infertility in men. Since there is an effective surgical treatment, it should be suspected in patients with obstructive azoospermia. The present video aims to illustrate the technical details of the surgical method. We present the clinical case of a 40-year-old man who seeks medical advice for 2.5 years of primary infertility without other medical history of interest. At the physical exam he presents symmetric testicles of 20cc and palpable bilateral vas deferens without varicocele. The semionogram shows cryptozoospermia, ejaculate volume <1ml and low pH (6.5). Blood test show normal testosterone, FSH and LH. He proceeds to cryopreserve a semen sample of ejaculated semen. We complete the study with a transrectal ultrasound where we observe dilatation of the ejaculatory ducts, seminal vesicles and a 14x12 mm midline prostatic cyst. We propose him to perform a transurethral resection of ejaculatory ducts (TURED). After dissection of both vas deferens, we perform a vasogram and posterior TURED guided by the instillation of indigo carmine through the vas deferens. The patient is discharged the next day, with a control seminogram on the 7th postoperative day that shows volume of 3,9 ml with 0’87x106 sperm/ml (motility a + b: 14.3%). 6 months later the sperm analysis shows a volume of 7.2 ml with 20,2x106 sperm/ml (motility a + b: 31%). One year after he has become a father.