Diagnosis and treatment of ejaculatory duct obstruction in male infertility

To discuss the diagnosis and treatment of ejaculatory duct obstruction in male infertility.

Twenty-four males were treated for ejaculatory duct obstruction between 1994 and 1998 in our clinic. Patients' age varied between 20 and 40 (mean=29). Ejaculatory duct obstruction was considered in patients with low to normal ejaculate volume, azoospermia or oligospermia, decreased motility, normal serum gonadotropin and testosterone levels, absent or low fructose in the ejaculate and evidence of obstruction on transrectal ultrasonography. The definitive diagnosis was made by the absence of efflux of methylene blue injected through the vas during cytoscopy. All the patients were subjected to transurethral resection of ejaculatory ducts and spermograms before and 3 months after resection were compared.

Before transurethral resection mean sperm count was 1.66x10(6)/ml compared to 25.4x10(6)/ml postoperatively. The difference was statistically significant (p=0.001). After the operation, 58.3% of the cases had improvement in sperm motility, and 62.5% had increased ejaculate volume. No significant complications occurred, and in only 1 (4.17%) patient, there was persistent hematuria. After a mean follow-up period of 9 (6-18) months, 6 (25%) pregnancies were noted.

Although transurethral resection is an effective method for the treatment of ejaculatory duct obstruction, the pregnancy rate is low, which could be related to the hazardous effects of urinary reflux into ejaculatory ducts or functional abnormalities of seminal vesicles.