The clinical curative effect of transurethral resection of the ejaculatory duct for iatrogenic ejaculatory duct obstruction after prostatic hyperthermia.
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Adult↗
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[Transurethral endoscopic treatment for chronic hematospermia caused by müllerian duct cyst and ejaculatory duct obstruction].
Between June 1997 and September 1999, we performed transurethral unroofing (TUUR) in three patients with hematospermia that recurred repeatedly for one year or more. Patient 1 (48 years old) and Patient 2 (59 years old) were diagnosed as having müllerian duct cysts that communicated with the left ejaculatory duct, and Patient 3 (36 years old) as an ejaculatory duct obstruction with the right ejaculatory duct dilation. A mixture of water-soluble contrast medium and indigocarmine blue dye was injected into the cysts and the ejaculatory duct cavity after incision of the vas deferens in Patients 1 and 3, and by cyst puncture under transrectal ultrasound (TRUS) guidance in Patient 2. Then the urethra was incised between the bladder neck and the verumontanum using a Collins' hot knife electrode, and spouting of the dye from the incision was judged to indicate successful unroofing. In Patient 2, safe and simple TUUR was possible by identifying the cyst location and its distance from the knife electrode under TRUS guidance. Hematospermia resolved after surgery in all three patients and there has been no recurrence for 1.3-3.5 years (mean: 2.6 years). Thus, TUUR was effective for treating chronic hematospermia caused by müllerian duct cyst and ejaculatory duct obstruction. For safe and reliable performance of this treatment, TRUS guidance and injection of the dye into the cyst and ejaculatory duct cavity can be recommended.
Adult↗
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.
Adult↗
Transrectal ultrasonography in the diagnosis and management of ejaculatory duct obstruction.
Ejaculatory duct obstruction is a rare but treatable cause of male infertility. The most common etiologies include congenital anomalies of the wolffian and Mullerian ducts, trauma, and inflammation. The diagnosis of ejaculatory duct obstruction should be suspected in any azoospermic patient with low ejaculate volume. Transrectal ultrasonography is now the preferred imaging modality for these patients. Seminal vesicle aspiration documents the presence of obstruction, confirms the presence of intact spermatogenesis, and rules out more proximal obstruction. Seminal vesiculography provides important anatomic information that may be helpful in determining the best method of treatment. It is a useful adjunct during transurethral resection of the ejaculatory ducts. Transurethral resection of the ejaculatory ducts is the standard method of treatment for ejaculatory duct obstruction, but balloon dilation may be preferred in select patients with an extraprostatic obstruction of the ejaculatory ducts. The exact criteria for the diagnosis of partial ejaculatory duct obstruction are still unclear, and therapy for these patients should be considered investigational at this time.
Constriction, Pathologic↗
Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms.
OBJECTIVES: To report our experience with transurethral resection of the ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction (EDO). PATIENTS AND METHODS: Before surgery, all patients complained of a decrease in the volume of their ejaculate, 14 of 15 had a non-projectile ejaculation, nine had a genitourinary infection necessitating antibiotic treatment, and five had pain with orgasm. The mean ejaculate volume and total motile sperm count was 1.1 mL and 8.1 million sperm per ejaculate. After surgery, at a mean follow-up of 2 months, 10 men reported having projectile ejaculation, and eight reported a marked improvement in their sensation of orgasm. Overall, 14 men reported a subjective improvement in their ejaculation. The average postoperative ejaculate volume was 2.3 mL and the total motile sperm count was 38.1 million per ejaculate. CONCLUSIONS: Men with symptomatic EDO who underwent TURED showed improvements in their ejaculation, sensation of orgasm, semen analysis values and fertility.
Constriction, Pathologic↗
Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction.
Ejaculatory duct obstruction is a rare but significant cause of male factor infertility. Vasography is the current gold standard for the diagnosis of complete obstruction of the ejaculatory ducts. However, there is currently no reliable method to diagnose partial obstruction. We performed seminal vesicle aspiration under transrectal ultrasonographic guidance in 11 infertile men to assess the use of this diagnostic test in the evaluation and management of patients with ejaculatory duct obstruction. The absence of sperm within the seminal vesicle aspirate from 8 patients who had sperm in the ejaculate demonstrates that sperm are not normally present within the seminal vesicles. Numerous motile sperm were observed in the seminal vesicle aspirate from an azoospermic patient in whom vasography documented complete ejaculatory duct obstruction, demonstrating that sperm can reflux into the seminal vesicles in patients with distal obstruction. Two patients with suspected partial ejaculatory duct obstruction had sperm in the seminal vesicles. In conclusion, sperm are not normally present within the seminal vesicles and ejaculatory duct obstruction should be suspected in any patient with numerous sperm within the seminal vesicles.
Adult↗
Transurethral resection of cystic and non-cystic ejaculatory duct obstructions.
Ejaculatory duct obstructions are diagnosed in approximately 5% of azoospermic men and can be treated by transurethral resection (TURED) or incision of the ducts. Eight patients with azoospermia and ejaculatory duct obstructions were treated by TURED after clinical examination, semen analysis, biochemical analysis of seminal plasma, endocrine analysis, transrectal ultrasonography and testicular biopsy. In 3/3 cases of cystic and in 3/5 cases of non-cystic obstruction. TURED of the stenosis was possible. During a follow-up of 12 months there was an increase in semen volume and sperm count in 3/3 and 3/5 patients, respectively. No pregnancy was achieved during the period up to 12 months. Clinical symptoms such as haemospermia and pain disappeared in all cases. In our cases and another 98 cases of ejaculatory duct obstructions documented in the literature, men of semen quality improved in 38-60% with a pregnancy rate of men 22-31% after TURED. We conclude that there is a correlation between the aetiology of ejaculatory duct obstructions and success rate of TURED.
Constriction, Pathologic↗
Successful treatment of azoospermia secondary to ejaculatory duct cyst.
Ejaculatory duct obstruction is considered a rare cause of infertility. Two cases are reported of an ejaculatory duct cyst with azoospermia preoperatively diagnosed by transrectal ultrasonography. The diagnosis of ejaculatory duct obstruction in one patient was confirmed by vasography with a combined iodinated contrast medium and methylene blue solution for radiological and direct visualization. Transrectal puncture and contrast filling of the cyst under the transrectal ultrasonographic guidance diagnosed the other patient. On the basis of these findings transurethral unroofing of the cyst was performed successfully. Transrectal ultrasonography facilitates evaluation and treatment of azoospermia caused by ejaculatory duct obstruction and may minimize the need for more invasive studies in such cases.
Adult↗
Diagnosis and management of ejaculatory duct obstruction.
Ejaculatory duct obstruction is a rare but correctable cause of male infertility. Complete ejaculatory duct obstruction may be diagnosed by transrectal ultrasonography and the presence of numerous sperm within the seminal vesicles of an azoospermic patient. Partial ejaculatory duct obstruction is difficult to document and therapy of this disorder should be considered investigational.
Angiography↗
Diagnosis and management of ejaculatory duct obstruction.
Ejaculatory duct obstruction is a rare but important cause of male infertility. The differential diagnosis, evaluation and treatment of patients with suspected ejaculatory duct obstruction is described herein. New minimally invasive techniques that can be utilized in both the diagnosis and treatment of ejaculatory duct obstruction are described.
Catheterization↗
[Transrectal ultrasound-guided ethanol sclerotherapy for Müllerian duct cyst accompanied with ejaculatory duct obstruction].
OBJECTIVE: To evaluate the efficacy and safety of transrectal ultrasound-guided ethanol sclerotherapy in the treatment of Müllerian duct cyst accompanied with ejaculatory duct obstruction. METHODS: Under the transrectal ultrasound guidance, 3 cases of prostate Müllerian duct cyst were treated by 20 G needle puncture and ethanol injection, and closely followed up by ultrasonic monitored on follow-up examinations. RESULTS: All the cysts involuted completely 6 months after the treatment. Symptoms caused by ejaculatory duct obstruction were relieved in all the patients. No severe complications occurred. CONCLUSION: Transrectal ultrasound-guided ethanol sclerotherapy is an effective and safe method for the treatment of Müllerian duct cyst accompanied with ejaculatory duct obstruction.
Adult↗
MR findings of ejaculatory duct cysts.
Ejaculatory duct cysts are a rare type of prostatic cysts. We report 3 cases of symptomatic ejaculatory duct cysts which have been explored by MR imaging. The MR findings were round or oval masses, medial or paramedial in the prostatic gland above the level of the verumontanum, extending into the prostatic base. They displayed a low signal intensity on T1-weighted images and high signal intensity on T2-weighted images (2 cases) or high signal intensity on both T1- and T2-weighted images (1 case). The diagnosis was confirmed by an ultrasonographically guided transperineal aspiration demonstrating spermatozoa in the cyst fluid.
Adult↗
Transurethral resection of the ejaculatory duct.
Complete bilateral ejaculatory duct obstruction has long been recognized as an uncommon, treatable form of male infertility. Partial ejaculatory duct obstruction reflects a disturbance of ejaculation where sperm quality is impaired during transit through the distal vas deferens and ejaculatory ducts. With the advent and increased use of high-resolution transrectal ultrasonography, abnormalities of the distal ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. In an infertile man with oligospermia or azoospermia with low ejaculate volume, normal secondary sexual characteristics, testes and hormonal profile and dilated seminal vesicles, midline cyst, or calcification on transrectal ultrasonography, ejaculatory duct obstruction is suggested. Of course, other causes of infertility may be concomitantly present and need to be searched for and treated as well. In selected cases, transurethral resection has resulted in marked improvement in semen parameters and pregnancies have been achieved. As is the case with all surgical procedures, proper patient selection and surgical experience are necessary to obtain optimal results. However, it appears that the treatments currently available for relief of ejaculatory obstruction are not optimally effective. Only approximately one half of treated patients will have an improvement in semen parameters and only about one quarter of treated patients will contribute to a pregnancy. What remains to be determined is how to manage the additional nearly 50% of patients who do not benefit from transurethral resection of ejaculatory obstruction. Based on my experience, I suggest that transrectal ultrasonography should be the first diagnostic procedure used when infertile men are suspected of having ejaculatory duct obstruction; however, vasography should still be considered for a more comprehensive diagnosis of ejaculatory duct obstruction. In patients showing atrophic seminal vesicles on transrectal ultrasonography and having a history of pulmonary tuberculosis, further study is not necessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. Qualitative measurement of semen fructose may be helpful in the diagnosis of partial ejaculatory duct obstruction. Patients having midline cyst and being treated by transurethral resection are expected to have the best outcome.
Ejaculatory Ducts↗
Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms.
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Blood↗
Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms.
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Adult↗
Urine contamination of seminal fluid after transurethral resection of the ejaculatory ducts.
Transurethral resection of ejaculatory duct obstruction has assumed a significant role in the treatment of infertile men. The potential impact of disruption of the ejaculatory duct apparatus after transurethral resection has not been studied. The seminal plasma of patients was evaluated after transurethral resection of the ejaculatory ducts by determining creatinine levels as a measure of urine contamination of semen. Analysis of semen parameters was retrospectively performed on preoperative and postoperative samples in 8 subfertile men diagnosed with ejaculatory duct obstruction treated by transurethral resection. These were not 8 consecutive patients but rather individuals from a larger series who had seminal plasma frozen preoperatively and postoperatively. A significant increase in seminal plasma creatinine levels postoperatively was detected in 7 of 8 patients evaluated. In patients who were requested to produce 2 specimens within 1 hour high levels of creatinine were found in both ejaculates, although creatinine levels were lower in the second ejaculate. The patient who postoperatively had low levels of creatinine in seminal plasma demonstrated an improvement in sperm concentration and morphology, and his wife became pregnant. Transurethral resection of the ejaculatory ducts results in marked improvement in some semen parameters. However, the impact of urine contamination in semen after transurethral resection of the ejaculatory ducts must be assessed in the management of patients who present with ejaculatory duct obstruction.
Adult↗
Fine structure of the epithelium of the human ejaculatory duct.
Normal human ejaculatory ducts were examined by scanning and transmission electron microscopy. The lumen, which shows an irregular shape due to complex mucosal folds, is lined by a simple secretory epithelium. A strong cell polymorphism has been observed concerning cell height, nuclear shape, and amount of secretory organelles. Apart from small differences, the epithelium appears to be identical to that of the seminal vesicle and deferential ampulla. These observations demonstrate that the human ejaculatory duct is not only a passage for semen, but also contributes to its formation.
Aged↗
Antegrade ejaculatory duct recanalization and dilation.
Ejaculatory duct obstruction is a rare but correctable cause of male infertility. Standard therapy is transurethral resection of the ejaculatory ducts, which is frequently complicated by seminal vesicle urinary reflux and is contraindicated when the obstruction is located outside the prostate gland. Herein, we report a minimally invasive technique that successfully dilated the ejaculatory duct without complications in a patient with unilateral, complete ejaculatory duct obstruction located outside the prostate.
Adult↗