Transurethral resection of the ejaculatory ducts: etiology of obstruction and surgical treatment options.
Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected 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 transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.
['Avellino|Gabriella J|GJ|', 'Lipshultz|Larry I|LI|', 'Sigman|Mark|M|', 'Hwang|Kathleen|K|']
D053713:Azoospermia D004543:Ejaculatory Ducts D004724:Endoscopy D005298:Fertility D006801:Humans D007248:Infertility, Male D008297:Male D012307:Risk Factors D020554:Sperm Injections, Intracytoplasmic D053625:Sperm Retrieval D016896:Treatment Outcome D018084:Ultrasonography, Interventional D013521:Urologic Surgical Procedures, Male
ejaculatory duct obstruction Male infertility transurethral resection of ejaculatory duct