V9-10 TRANSURETHRAL RESECTION OF EJACULATORY DUCTS: A STEP-BY-STEP GUIDE

Abstract

You have accessJournal of UrologyInfertility, ED, and Reconstruction Lower Tract (II)1 Apr 2017V9-10 TRANSURETHRAL RESECTION OF EJACULATORY DUCTS: A STEP-BY-STEP GUIDE Luis Savio, Joseph Palmer, Nachiketh S Prakash, Raul Clavijo, Desmond Adamu, and Ranjith Ramasamy Luis SavioLuis Savio More articles by this author , Joseph PalmerJoseph Palmer More articles by this author , Nachiketh S PrakashNachiketh S Prakash More articles by this author , Raul ClavijoRaul Clavijo More articles by this author , Desmond AdamuDesmond Adamu More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2446AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. Transurethral resection of the ejaculatory ducts (TURED) serves as an important therapeutic management option for partially and/or completely obstructed ejaculatory ducts (EDs) that may result in significant improvement of semen parameters and pregnancy rate. The aim of this study is to demonstrate the key components for completing a successful TURED. METHODS We present a case of a 40-year-old man who presented with primary infertility. His past medical history was otherwise not significant. Physical examination revealed non-tender 14cc testes bilaterally with present and non-tender vas deferens and epididymis. Hormone studies were within the normal range. Semen analysis was abnormal (pH 6.4, volume of 0.7cc, concentration 16 million/cc and 7% motility). A trasnrectal ultrasonography revealed dilated seminal vesicles measuring more than 1.5 cm and seminal vesicle aspiration detected no sperm in the aspirate. We began the procedure by placing the patient in the conventional lithotomy position. Transrectal ultrasonography-guided seminal vesicle puncture was performed and methylene blue was injected into both seminal vesicles. Cystoscopy was performed focusing in the area of the verumontanum to assess for methylene blue drainage in order to more precisely proceed with resection of the ejaculatory ducts.Vesiculography was performed by placing a 5 French ureteral into the freshly opened EDs in order to assess for patency and confirm both sides had been opened. Hemostasis was performed carefully in order not to occlude the newly open EDs. RESULTS Patient was discharged home with foley catheter in place with a voiding trial performed one day later. He returned to clinic at 2 weeks for a post-operative evaluation. Semen analysis revealed improved parameters (pH 7.2, volume of 1cc, concentration 20 million/cc and 60% motility). CONCLUSIONS The key portions for performing a successful TURED includes seminal vesicle instillation of methylene blue for easier ED identification. Vesiculography is performed near the end of the procedure to ensure both EDs have been opened as well as to assess for passive drainage of the seminal vesicles through the newly open EDs. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1059 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Luis Savio More articles by this author Joseph Palmer More articles by this author Nachiketh S Prakash More articles by this author Raul Clavijo More articles by this author Desmond Adamu More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...