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Transurethral resection of the ejaculatory duct
1Department of Urology, Seoul National University College of Medicine, Korea.
Summary
Ejaculatory duct obstruction causes male infertility, often diagnosed with transrectal ultrasonography. Transurethral resection offers some improvement, but new management strategies are needed for non-responders.
Area of Science:
- Reproductive Medicine
- Urology
- Andrology
Background:
- Ejaculatory duct obstruction (EDO) is an uncommon cause of male infertility.
- High-resolution transrectal ultrasonography (TRUS) aids in diagnosing distal ejaculatory duct abnormalities.
- Suggestive clinical findings include oligospermia/azoospermia, low ejaculate volume, and specific TRUS findings.
Purpose of the Study:
- To review the diagnosis and management of ejaculatory duct obstruction.
- To evaluate the effectiveness of current treatments like transurethral resection.
- To suggest optimal diagnostic and therapeutic approaches for male infertility due to EDO.
Main Methods:
- Review of clinical findings suggestive of EDO.
- Utilizing transrectal ultrasonography (TRUS) for diagnosis.
- Evaluation of transurethral resection of the ejaculatory duct (TURED) outcomes.
- Consideration of vasography and semen fructose analysis.
Main Results:
- TRUS is a key diagnostic tool, revealing abnormalities like dilated seminal vesicles, midline cysts, or calcifications.
- Transurethral resection improves semen parameters in about 50% of patients and leads to pregnancy in about 25%.
- Outcomes vary, with midline cysts showing the best response to TURED.
Conclusions:
- EDO is a treatable cause of male infertility, but current treatments are not optimally effective.
- TRUS is recommended as a first-line diagnostic procedure for suspected EDO.
- Further research is needed for managing patients who do not benefit from TURED.