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Ejaculatory duct obstruction in infertile men
1Department of Urology and Radiology, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Insights
Ejaculatory duct obstruction (EDO) in infertile men is best diagnosed with transrectal ultrasonography (TRUS). Treatment outcomes vary by cause, with midline cysts yielding the best results after transurethral resection.
Area of Science:
- Reproductive Medicine
- Urology
- Andrology
Background:
- Male infertility is a significant concern, with ejaculatory duct obstruction (EDO) being a contributing factor in some cases.
- Understanding the diagnostic pathways and treatment outcomes for EDO is crucial for improving fertility in affected men.
Purpose of the Study:
- To analyze the experience with ejaculatory duct obstruction (EDO) in infertile men.
- To evaluate diagnostic steps and management outcomes based on the etiology of EDO.
Main Methods:
- A 7-year retrospective analysis of 50 infertile men diagnosed with EDO.
- Diagnostic tools included history, physical examination, semen analysis, semen fructose, hormonal studies, testicular biopsy, transrectal ultrasonography (TRUS), and vasography.
- Treatment involved transurethral resection or forced lavage via vasotomy.
Main Results:
- Complete EDO characteristics were observed in 45 men; partial EDO showed variable seminal values with low semen fructose (< 1.4 g/L).
- Common causes included midline cysts (16), tuberculosis (17), Wolffian malformation (4), and idiopathic (8).
- Overall improvement in semen values and paternity rates were 61% and 26%, respectively. Midline cysts treated with transurethral resection showed the best outcomes.
Conclusions:
- Transrectal ultrasonography (TRUS) is recommended as the primary diagnostic tool for suspected EDO.
- Vasography can provide a more comprehensive diagnosis; semen fructose measurement aids in partial EDO detection.
- For patients with atrophic seminal vesicles and a history of tuberculosis, microscopic epididymal sperm aspiration for in vitro fertilization is suggested.
Objective:
To analyse our experience of ejaculatory duct obstruction (EDO) in infertile men, evaluating the diagnostic steps and the outcome of management according to the aetiology.
Patients And Methods:
Over a 7-year period, 50 infertile men were diagnosed with EDO as a contributory factor to male infertility. Diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, hormonal study, testicular biopsy, transrectal ultrasonography (TRUS) and/or vasography. Thirty-one patients with EDO were treated by transurethral resection (26) or forced lavage via a vasotomy (five).
Results:
In 45 of the 50 men, semen analyses showed the typical characteristics of complete EDO. Seminal values were variable in five cases of partial EDO; the semen fructose levels were < 1.4 g/L in all five. The main cause of EDO was a midline cyst in 16, Wolffian malformation in four, tuberculosis in 17, previous genitourinary infection in five and idiopathic in eight men. In 17 patients the seminal vesicles appeared to be atrophied on TRUS; 15 of these patients had a history of pulmonary tuberculosis and subsequent vasography in five showed multiple bilateral vasal obstruction. TRUS findings correlated well with vasography except in one case. The overall rate of improved semen values and paternity was 61% and 26%, respectively. Of 16 patients with midline cysts, 14 had improved semen variables and achieved paternity, seven after transurethral resection.
Conclusions:
TRUS should be the first diagnostic procedure used when infertile men are suspected of having EDO, but vasography should still be considered for a more comprehensive diagnosis. In patients with atrophic seminal vesicles on TRUS and with a history of pulmonary tuberculosis, further study is unnecessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. The measurement of semen fructose may be helpful in diagnosing partial EDO. Patients with midline cysts who are treated by transurethral resection are expected to have the best outcome.