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.