Ejaculatory duct manometry in normal men and in patients with ejaculatory duct obstruction

Area of Science:

• Urology
• Reproductive Medicine
• Diagnostic Tools

Background:

• Ejaculatory duct obstruction (EDO) is a treatable cause of male infertility.
• Diagnosis of EDO can be challenging, with current methods lacking definitive specificity or sensitivity, especially for partial obstructions.

Purpose of the Study:

• To introduce and evaluate a novel hydraulic test for diagnosing physical and functional ejaculatory duct obstruction.
• To establish baseline ejaculatory duct pressure values in fertile men.

Main Methods:

• A new ejaculatory duct injection and manometry test was performed on infertile men with suspected EDO and fertile controls.
• Ejaculatory duct opening pressure was measured before and after transurethral ejaculatory duct resection in patients with EDO.
• Pressures were compared between groups and correlated with treatment response.

Main Results:

• Fertile men (controls) had a mean opening pressure of 33.2 cm H2O.
• Men with suspected EDO had a significantly higher mean opening pressure of 116 cm H2O before treatment.
• Following transurethral ejaculatory duct resection, pressure decreased to 53 cm H2O, with 80% of patients showing improved ejaculate volume or sperm parameters.

Conclusions:

• Ejaculatory duct manometry provides a valuable diagnostic tool for EDO.
• Clinically suspected EDO is associated with elevated ejaculatory duct opening pressures compared to fertile men.
• Transurethral ejaculatory duct resection effectively reduces pressure and improves fertility outcomes.