Transurethral Endoscopic Treatment of Distal Seminal Tract Obstruction

Abstract

ABSTRACT: The two distal obstructive pathologies of the seminal duct found at our center are ejaculatory duct obstruction and utriculocele. Between 1979 and 1993, we present a total of 22 cases, 13 cases of ejaculatory duct obstruction and nine of utriculocele. The usual manifestations include infertility, ejaculatory discomfort, testicular pain, perineal discomfort, and hematospermia. Also, symptoms of urinary obstruction and repeated urinary infections can be present.The preparatory evaluation studies are many and varied. Excellent images are obtained with transrectal echography. In cases associated with infertility, very low seminal volume is recorded (1 ml or less) with azoospermia or oligospermia. The semen fructose is either very low or absent altogether. The serum FSH is normal. The testicular biopsy is indicative of the conservation of the spermatogenesis. It is also of prime importance to check that there is no epididymal tubular rupture caused by increased pressure or by epididymitis because a combination of endoscopic surgery with epididymovasostomy would then be necessary. Seminal vesiculography indicates the level of obstruction.A high scrotal incision was made over the vas deferens and the vas cannulated with a 24‐gauge intravenous catheter into which methylene blue was injected while the prostatic urethra was monitored under direct vision endoscopically (chromo‐ejaculoscopy). Endoscopic resection was accomplished and appearance of the blue dye could be used as a measure of adequate resection.An improvement in semen volume was observed in 14 patients, and in two patients pregnancies were obtained by means of assisted reproduction techniques. There were no serious complications in any of the cases; only two patients suffered postsurgical epididymitis.