Management of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy: Case Report and Literature Review

Ejaculatory duct obstruction is a rare condition identified in up to 5% of infertile men. Patients with ejaculatory duct obstruction can present with aspermia, azoospermia or oligoasthenospermia, painful ejaculation, hematospermia, prostatic pain, or male infertility. Semen analysis, transrectal ultrasonography, pelvic computerized tomography and magnetic resonance imaging are often used in the diagnostic work up, but with limited accuracy. While transurethral resection of the ejaculatory ducts has good efficacy for distal duct obstruction, results for proximal obstruction are less impressive, and it might cause severe complications, such as rectal injury and urinary incontinence. Recently, the use of high quality endourological devices and an improved understanding of ejaculatory ducts anatomy gleaned through the use of sophisticated imaging tools have led to the development of novel minimally invasive treatment options for this condition. The present study aims to report an index case of ejaculatory ducts obstruction managed with seminal vesiculoscopy, and review the current literature regarding this topic.