Transurethral Resection Of Ejaculatory Ducts Research Articles

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification.

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Transurethral resection of ejaculatory ducts (TURED) for the management of ejaculatory duct obstruction: a Saudi cohort

This retrospective study aimed to investigate the clinical characteristics, changes in semen parameters, and outcomes of adult patients with ejaculatory duct obstruction (EDO) who underwent transurethral resection of ejaculatory ducts (TURED). The study included 25 patients diagnosed with EDO who underwent TURED at King Faisal Specialist Hospital & Research Center in Saudi Arabia between January 2015 and December 2021. The results showed that 68% of the patients had complete ED obstruction, while 32% had partial obstruction. Primary infertility was reported in 68%of the patients, with 4% experiencing secondary infertility. The analysis revealed a significant increase in semen volume greater than 0.6 after TURED, while there was a significant decrease in volumes ranging from 0.1 to 0.3 and from 0.4 to 0.6. Patients with partial ED obstruction demonstrated a significant improvement in semen parameters compared to those with complete ED obstruction. The findings suggest that TURED is a safe and effective treatment option for EDO, leading to significant improvements in semen parameters and potentially resulting in spontaneous pregnancy. However, further research is needed to identify specific patient subgroups that may benefit the most from TURED. While magnetic resonance imaging (MRI) with an endorectal coil has been proposed for more detailed evaluation, transrectal ultrasound (TRUS) has been suggested as the standard examination technique.

Long-Term Success Durability of Transurethral Resection of Ejaculatory Duct in Treating Infertile Men with Ejaculatory Duct Obstruction.

Objectives: The current study aimed to evaluate the long-term outcomes of TURED (transurethral resection of the ejaculatory duct) in treating male infertility due to ejaculatory duct obstruction (EDO) to the short-term follow-up. Methods: From 2000 to 2010, we retrospectively reviewed 30 men with infertility resulting from EDO who underwent TURED. Information on preoperative evaluation of patients was collected from the medical records. Standardized semen analysis was performed 6 weeks, 3 months, and 12 months postoperatively, as well as after a 7-year follow-up. Results: The average age of patients was 35.5 ± 2.6. All patients had low ejaculate volume and normal range of the mean serum hormone levels (gonadotropins and testosterone). Transrectal ultrasonography (TRUS) assessment revealed midline cysts in 46.7% (n = 14 cases), a seminal vesicle dilatation in 83.3% (25/30 cases), and ejaculatory duct dilatation in 76.7% (23/30 patients). In addition, two patients (6.6%) underwent MRI pelvis to confirm equivocal EDO by TRUS. After short-term and long-term follow-up, semen parameters improved significantly in 90% of cases vs 63.3% of cases, respectively, with statistically insignificant differences in all parameters (p ≥ 0.1). Based on subgroup analysis, semen parameters improved in all partial EDO and cystic EDO cases vs complete EDO and noncystic EDO, respectively. Spontaneous pregnancies were achieved in 10 (33.3%) vs 8 (26.6%) cases after short and long term, respectively. Regarding post-TURED complications, we reported 23.3% (n = 7). Conclusion: TURED is an effective treatment for EDO. It significantly improves all semen parameters and improves the symptoms related to EDO after short and long-term follow-up.

Red Sky in Morning: A Case of Concurrent Hematospermia and Anorgasmia

ABSTRACT Introduction Hematospermia, or blood in the ejaculate, usually follows a benign course. However, it can be a source of considerable anxiety in patients. Similarly anorgasmia, or the inability to achieve orgasm despite adequate sexual stimulation may cause significant psychological distress. These rare conditions pose unique challenges for diagnosis and treatment and have distinct considerations when they occur together. Objective We present a case of concurrent hematospermia and anorgasmia with the diagnostic and treatment procedures for both. We report that simultaneous cystoscopy, electroejaculation (EEJ), transurethral resection of ejaculatory ducts (TURED), and seminal vesiculography is safe and effective as a diagnostic and treatment modality. Methods Medical history, physical exam, laboratory analyses of blood, urine, and semen were performed. A cystoscopic video of the prostatic urethra was recorded while performing EEJ, in order to observe hematospermia under direct vision. A TURED was then performed to evaluate the ejaculatory ducts and to facilitate seminal vesiculography. Results A healthy 36 year old man reported avoidance of all sexual activity after a few episodes of hematospermia due to extreme fear. He continued to note bloody discharge on occasion in the morning, attributing this to bloody nocturnal emissions. Despite normal erectile function, he adamantly avoided all sexual activity including masturbation. Prior STI workup, cystoscopy, urinalysis, urine and semen cultures were all negative. Prior treatments with finasteride, NSAIDs, and antibiotics failed to reduce the frequency of hematospermia, and he had minimal improvement in libido with cabergoline and buproprion. Concurrent urethroscopy and EEJ revealed initial hematospermia from bilateral ejaculatory ducts with normal, white emission after several seconds. A TURED and direct seminal vesiculography revealed hypoplastic seminal vesicles bilaterally. The patient tolerated the procedure well and had resolution of hematospermia post-operatively. He reports improvement in libido and willingness to attempt sexual activity. Conclusions Despite a usually benign clinical course, hematospermia can provoke great anxiety in patients to the point of avoidance of sexual activity. We propose a causal relationship between hematospermia and our patient's sexual dysfunction and anorgasmia, as the patient reports renewed interest in sex after his hematospermia resolved post-operatively. A thorough evaluation to rule out more serious pathology and to address the patient's anxiety included simultaneous cystoscopy, EEJ, TURED, and seminal vesiculography. This was both safe and effective in diagnosis and treatment of concurrent hematospermia and anorgasmia, and is the first video demonstration of simultaneous cystoscopy and EEJ reported in the literature to our knowledge. Disclosure No

V07-10 SEMINAL VESICULOSCOPY FOR DIAGNOSIS AND MANAGEMENT OF HEMATOSPERMIA

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-10 SEMINAL VESICULOSCOPY FOR DIAGNOSIS AND MANAGEMENT OF HEMATOSPERMIA Aaron Brant, Nahid Punjani, Christopher Gaffney, Jonathan Fainberg, and James Kashanian Aaron BrantAaron Brant More articles by this author , Nahid PunjaniNahid Punjani More articles by this author , Christopher GaffneyChristopher Gaffney More articles by this author , Jonathan FainbergJonathan Fainberg More articles by this author , and James KashanianJames Kashanian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hematospermia is an uncommon urologic complaint but a cause of significant distress in affected patients. It is associated with bothersome symptoms such as dysorgasmia and chronic pelvic pain. First line treatment options include antibiotics, non-steroidal anti-inflammatory drugs (NSAIDS), alpha blockers, and 5-alpha reductase inhibitors. For patients with refractory symptoms, operative intervention with transurethral resection of ejaculatory ducts (TURED) and seminal vesiculoscopy has been described. METHODS: We provide a step-by-step description of seminal vesiculoscopy, TURED, and seminal vesicle (SV) balloon dilation in a 28-year old male presenting with five years of refractory hematospermia and dysorgasmia. He had failed treatment with antibiotics, NSAIDS, tamsulosin, and finasteride. His infectious and sexually-transmitted infection work-up was normal. His semen analysis was notable for 16% motility, 3.4 million WBC/mL, and cloudy brown color. Imaging with ultrasound and MRI revealed right SV dilation and clot in the left SV. RESULTS: After a normal cystoscopy, the verumontanum was identified, and the left ejaculatory duct was successfully cannulated with a 5-french open-ended catheter over a 0.014-inch micro-guidewire. Transrectal ultrasound was used to confirm correct placement. After dilation with a percutaneous transluminal angioplasty balloon dilator, the left seminal vesicle was entered under direct vision with a 4.5 french semi-rigid ureteroscope. Significant debris were noted and removed via irrigation through a luer-lock syringe. Both ejaculatory ducts were resected using a monopolar loop. The right SV was then cannulated, dilated, and entered under direct vision. Blood clot and debris were removed via irrigation. There were no post-operative complications. At six- and twelve-months follow-up, the patient reported significant improvement in dysorgasmia and complete resolution of hematospermia. CONCLUSIONS: Seminal vesiculoscopy with transurethral resection of ejaculatory ducts and balloon dilation is an effective procedure for hematospermia refractory to medical therapy in the appropriately selected patient. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e554 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Nahid Punjani More articles by this author Christopher Gaffney More articles by this author Jonathan Fainberg More articles by this author James Kashanian More articles by this author Expand All Advertisement PDF downloadLoading ...

A systematic review of transurethral resection of ejaculatory ducts for the management of ejaculatory duct obstruction.

Ejaculatory duct obstruction (EDO) is an uncommon but potentially treatable cause of male factor infertility. However, there are limited data on transurethral resection of the ejaculatory ducts (TURED) as a treatment option. A systematic review was therefore conducted to assess its efficacy and identify patient subgroups that benefit from the procedure. A database search of PubMed, Embase, and Scopus (up to January 2019) and the World Health Organization trial registry was performed to identify all studies assessing infertile men with EDO undergoing TURED. The primary outcome measures included semen parameters and natural pregnancies. The secondary outcomes included complications, symptomatic improvement, and a change from in vitro fertilization to intrauterine insemination. Of 3,277 articles screened, 29 studies with 634 patients were included in the study. Although outcomes varied considerably among studies, a general increase in all semen parameters postoperatively was observed. Semen volume (n=23 studies) improved in a median of 83.0% of patients (interquartile range [IQR]: 37.5). Sperm motility and concentration (n=10 and n=21 studies) improved in a median of 63.0% (IQR: 15.0) and 62.5% (IQR: 16.5) of patients, respectively. The natural pregnancy rate across the studies was a median of 25.0% (IQR: 15.7). Improvements in both the outcomes were greater in patients with congenital etiologies and partial EDO. Differences in surgical technique did not appear to affect outcomes. TURED is associated with improvements in semen parameters and offers a chance of restoring fertility in previously subfertile men. Although results are promising, the current evidence remains limited owing to predominantly retrospective studies with small sample sizes.

Transurethral resection of ejaculatory duct combined with seminal vesiculoscopy for management of persistent or recurrent hemospermia in men with ejaculatory duct obstruction

BackgroundPersistent or recurrent haemospermia often occurs in individuals with ejaculatory duct obstruction (EDO). This study aimed to evaluate the efficacy and safety of transurethral resection of the ejaculatory duct (TURED) combined with seminal vesiculoscopy in treating persistent or recurrent haemospermia in men with EDO.MethodsFrom June 2014 to March 2018, 103 consecutive patients with EDO who underwent TURED combined with seminal vesiculoscopy for persistent or recurrent haemospermia at the Department of Urology of West China Hospital were enrolled into this retrospective study. The patients were evaluated mainly by detailed history-taking and performing semen analysis, transrectal ultrasonography, and magnetic resonance imaging.ResultsAmong the 103 patients, 79 (76.70%) had cysts of the lower male genitourinary tract; 63 (61.17%) had blood clots; and 32 (31.07%) had calculi in the seminal vesicle and/or prostatic utricle. The duration of postoperative follow-up was 12 months, and the symptoms of haemospermia disappeared in 96 (93.20%) patients. There was no significant difference in the semen PH and sperm count before and after surgery; however, the ejaculate volume and sperm motility significantly improved postoperatively. Except for two cases of acute urinary retention and one case of watery ejaculate after surgery, no severe postoperative complications, including epididymitis, urethral stricture, urinary incontinence, retrograde ejaculation, or rectal injury, were observed.ConclusionTURED combined with seminal vesiculoscopy is a suitable method for the diagnosis and treatment of persistent or recurrent haemospermia in men with EDO.

Transurethral Resection of Ejaculatory Duct in Primary Infertile Men with Distal Ejaculatory Duct Obstruction

Transurethral Resection of Ejaculatory Duct in Primary Infertile Men with Distal Ejaculatory Duct Obstruction

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

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.

Transurethral resection of ejaculatory ducts: a step-by-step guide

To demonstrate the key components for completing a successful transurethral resection of ejaculatory ducts (TURED) for completely obstructed ejaculatory ducts (EDs). Video presentation. University Hospital. A 40-year-old man presenting with primary infertility and abnormal semen analysis (pH 6.4, volume of 0.7 cc, concentration 16 million/cc, and 7% motility) in whom a transrectal ultrasonography revealed dilated seminal vesicles measuring more than 1.5 cm and seminal vesicle aspiration detected no sperm in the aspirate. Transurethral resection of ejaculatory ducts. Intraoperative technique with commentary highlighting tips for a successful TURED. This video provides a step-by-step guide for TURED, including transrectal ultrasonography-guided seminal vesicle puncture for instillation of methylene blue to allow more precise identification of EDs. Vesiculography was performed near the end of the procedure to assess for patency of EDs and confirm both sides had been opened. (Institutional review board approval was obtained for this presentation.) CONCLUSION(S): The key portions for performing a successful TURED includes seminal vesicle instillation of methylene blue for easier identification of EDs. 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.

268 Transurethral Resection of Ejaculatory Ducts Had Less Benefit in the Treatment of Chinese Azoospermic or Severe Oligozoospermic Patients With Polycystic Kidney Disease and Concomitant Seminal Megavesicles

268 Transurethral Resection of Ejaculatory Ducts Had Less Benefit in the Treatment of Chinese Azoospermic or Severe Oligozoospermic Patients With Polycystic Kidney Disease and Concomitant Seminal Megavesicles

Hybrid Method of Transurethral Resection of Ejaculatory Ducts Using Holmium:Yttriumaluminium Garnet Laser on Complete Ejaculatory Duct Obstruction

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.

Transurethral resection of ejaculatory duct in infertile men: outcome and predictors of success

To evaluate the outcome of transurethral resection of the ejaculatory duct (TURED) in the treatment for ejaculatory duct obstruction (EDO) and define predictors of success. We retrospectively evaluated 23 infertile men between 2006 and 20011, who were diagnosed as having EDO. Inclusion criteria were azoospermia or oligozoospermia, low ejaculate volume, low ejaculate PH, little or no fructose in seminal plasma with normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonography (TRUS) or magnetic resonance images (MRI). Seventeen patients were diagnosed as complete EDO, and the remaining 6 were considered as having partial EDO. All patients were treated by TURED. Midline cysts were diagnosed in seven cases, and the remaining 16 patients had postinflammatory obstruction of ejaculatory ducts (ED). Overall, a significant improvement of semen quality was achieved after surgery. All patients with partial EDO showed improvements in semen parameters after TURED compared to 23.5% (4/17) in those with complete EDO. Improvement in sperm count was 71.5% and 31% for patients with midline cysts and patients with non-cystic causes of EDO, respectively. Six (26%) patients developed complications including epididymo-orchitis in 2, watery ejaculate in 3 and conversion to azoospermia in 1. Spontaneous pregnancies were achieved in 3 (13%) cases: 2 (33.3%) men with partial and 1 (5.9%) with complete obstruction. Partial EDO, whatever the etiology, has an excellent outcome after TURED. Complete EDO due to cysts appears to respond better than postinflammatory obstruction to TURED.

Transurethral Seminal Vesiculoscopy Using a 6F Vesiculoscope for Ejaculatory Duct Obstruction: Initial Experience

Ejaculatory duct obstruction (EDO) is a surgically correctable condition that occurs in some infertile men. The standard therapy is transurethral resection of ejaculatory ducts (TURED). However, TURED has been associated with a high risk of complications, including the impairment of semen parameters and retrograde ejaculation. In our clinical practice, vesiculoscopy has demonstrated potential as a minimally invasive alternative technique for the diagnosis and treatment of EDO. Very few studies have examined transurethral seminal vesiculoscopy (TRU-SVS) in recent years, and no study has examined 6F vesiculoscopes. Therefore, we performed a retrospective study of TRU-SVS using a 6F vesiculoscope and its effect on the diagnosis and treatment of EDO. A total of 21 patients who underwent this procedure were included in the study. The mean patient age was 28.8 years (range, 23-36 years). The procedure was completed successfully in all patients within a mean time of 31.5 minutes and a mean hospital stay of 1.17 days. All patients had EDO. Calculi were found in the ejaculatory ducts or in the seminal vesicles of 5 patients. Sperm was detected in 11 patients 1-3 months postsurgery and in another 8 patients 3-12 months postsurgery. No sperm was detected in the remaining 2 patients by 12 months postsurgery. Epididymitis, retrograde ejaculation, urinary incontinence, and rectal injury were not observed. These data indicate that TRU-SVS using a 6F vesiculoscope affords direct access to the seminal vesicle and offers the advantages of fewer complications and more optimal sperm recovery as well as direct, dynamic video imaging.

Nursing of patients with obstruction of ejaculatory duct undergoing transurethral resection of ejaculatory ducts

目的 探讨经尿道射精管口电切术围手术期的护理特点.方法 回顾性分析30例梗阻性无精子症患者的临床资料.结果 30例患者均顺利康复出院;平均留置导尿管时间10 d;平均血尿时间1.5 d;平均住院时间8 d;术后无严重并发症发生.结论 充分的术前准备和术后重视导尿管护理,严密病情观察,及早发现和治疗并发症的发生是手术成功的保证,有效的健康指导可促进患者的生育能力得到早日康复。

Transrectal Ultrasound- and Fluoroscopic-Assisted Transurethral Incision of Ejaculatory Ducts: A Problem-Solving Approach to Nonmalignant Hematospermia Due to Ejaculatory Duct Obstruction

Ejaculatory duct obstruction (EJDO) has traditionally been managed with transurethral resection of ejaculatory ducts (TURED). However, wide resection has potential complications and risk of postoperative morbidity. We demonstrate a technique using transrectal ultrasonography (TRUS) and fluoroscopy to assist with transurethral incision of the ejaculatory duct (TUIED) to treat hematospermia due to obstruction by either a stone or a prostatic cyst. Twenty-five patients with ejaculatory disorders including hematospermia underwent TUIED between 1997 and 2005. Diagnosis, the cause of hematospermia, and the level of EJDO was confirmed by semen analysis, semen culture, and TRUS. All patients were subjected to TRUS-guided seminal vesicle aspiration followed by seminal vesiculography using methylene blue mixed with contrast under biplanar TRUS guidance and fluoroscopic monitoring. After confirming the cause and level of obstruction, the ejaculatory duct was opened using endoscissors until the obstruction was relieved as confirmed by free flow of methylene blue. Stones were removed if any were present. A Foley catheter was kept in place for 24 hours. Improvement of symptoms was noted in 96% of patients with ejaculatory disorders. All patients with painful ejaculation and hematospermia had complete remission of symptoms at 3 months postoperatively; three patients had transient epididymo-orchitis, and none had retrograde ejaculation or incontinence. TUIED is a viable and minimally-invasive option for treating EJDO causing ejaculatory disorders including hematospermia with minimal morbidity and early recovery.

Transurethral resection of ejaculatory ducts in the treatment of complete ejaculatory duct obstruction

To evaluate the value of transurethral resection of the ejaculatory duct (TURED) in the treatment of complete ejaculatory duct obstruction (EDO) as a treatable cause of male factor infertility. We retrospectively evaluated 12 azoospermic infertile men who were diagnosed as having complete EDO. The mean age of the patients was 32 years (range 24-40). Inclusion criteria were EDO in patients with azoospermia, normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonographic (TRUS) images. The definitive diagnosis was based on the absence of an efflux of methylene blue injected through the seminal vesicles during cystoscopy. All patients were treated by TURED. Before TURED, all patients were azoospermic and had been considered as candidates for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Following the operation, sperms were seen in the ejaculates of 11/12 patients. After a mean follow-up period of 12 (range 4-36) months, five (41.6%) pregnancies were noted (three spontaneous, one with intrauterine insemination and one with IVF/ICSI). Transurethral resection was found to be a safe and somewhat effective approach for the treatment of EDO. After TURED, a significant improvement was achieved in semen parameters, and spontaneous pregnancy resulted in three cases. In addition, TURED can reduce the need for expensive procedures such as IVF/ICSI as this modality allows IVF/ICSI to be performed with ejaculated instead of surgically retrieved sperm.

Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment

Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.

Surgical therapy for azoospermia with ejaculatory duct obstruction

To investigate the effect of transurethral resection of ejaculatory ducts (TURED) for azoospermia with ejaculatory duct obstruction (EDO). From June 2003 to December 2004, 20 azoospermia with EDO were diagnosed, diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, endocrine assessment, testicular biopsy and transrectal ultrasonography (TRUS); All 20 cases were treated by TURED. Fifteen of them were followed up more than 3 months after the treatment. The semen samples of them were analysed at 3-month intervals in post-therapy. Semen analyses in all 20 cases showed the typical characteristics of EDO, low semen volume (0.4-1.6 ml), azoospermia, low pH, absent or low semen fructose. TRUS showed the main etiology factor of EDO was a midline cyst in 11, lateral cystic lesions in 2, the remaining 7 cases had dilated ejaculatory duct with or without dilated seminal vesicles. Among 15 cases followed up more than 3 months after TURED, 10/15 (67%) had an improvement in semen parameters and 3/15 (20%) had pregnancies. Semen analyses had not been done in anther 5 cases. Transurethral resection of ejaculatory ducts may be a safe and effective method for the treatment of azoospermia with EDO.

SECONDARY EJACULATORY DUCT OBSTRUCTION: MANAGEMENT BY SECONDARY TRANSURETHRAL RESECTION OF EJACULATORY DUCT

Distal ejaculatory duct obstruction (EDO) is a relatively rare but surgically treatable cause of male infertility. Transrectal ultrasonography (TRUS) has been commonly used in infertility evaluation in recent years. These pathologies are more common than expected and treated with transurethral resection of ejaculatory duct (TURED). Although TURED is the recommended routine procedure for all cases of EDO, it has complications, such as iatrogenic obstruction, in 4% of the cases. Herein, we evaluated a patient who had developed EDO secondary to TURED.