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Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology?
A Kadioglu1, S Cayan, A Tefekli
1Department of Urology, Medical Faculty of Istanbul, University of Istanbul, University of Istanbul, Istanbul, Turkey.
Objective:
To describe the pathology-specific response to transurethral resection of ejaculatory ducts (TURED) in patients with complete or partial ejaculatory duct obstruction and to evaluate the role of TURED in light of powerful assisted reproductive technologies.
Design:
Retrospective clinical study.
Setting:
University hospital.
Patient(S):
Thirty-eight infertile men with obstruction of the ejaculatory ducts.
Intervention(S):
Diagnosis by transrectal ultrasonography or magnetic resonance imaging, and treatment with TURED.
Main Outcome Measure(S):
Changes in semen variables, pregnancy outcomes, and complication rates were analyzed before and after surgery.
Result(S):
Improvement in semen variables was significantly better in patients with partial obstruction (94%) of ducts than in those with complete obstruction (59%) (P=.04). Cystic obstruction, especially midline and eccentric cysts, responded best to TURED. Before surgery, all patients were candidates for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospermic men conceived spontaneously or were referred for IUI instead of IVF/ICSI.
Conclusion(S):
Ejaculatory duct obstruction due to cysts appears to respond best to TURED. In addition, TURED may decrease the need for IVF/ICSI as primary treatment in many cases. Finally, TURED may allow IVF/ICSI to be performed with ejaculated rather than surgically retrieved sperm.