Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction

Ejaculatory duct obstruction is a rare but significant cause of male factor infertility. Vasography is the current gold standard for the diagnosis of complete obstruction of the ejaculatory ducts. However, there is currently no reliable method to diagnose partial obstruction. We performed seminal vesicle aspiration under transrectal ultrasonographic guidance in 11 infertile men to assess the use of this diagnostic test in the evaluation and management of patients with ejaculatory duct obstruction. The absence of sperm within the seminal vesicle aspirate from 8 patients who had sperm in the ejaculate demonstrates that sperm are not normally present within the seminal vesicles. Numerous motile sperm were observed in the seminal vesicle aspirate from an azoospermic patient in whom vasography documented complete ejaculatory duct obstruction, demonstrating that sperm can reflux into the seminal vesicles in patients with distal obstruction. Two patients with suspected partial ejaculatory duct obstruction had sperm in the seminal vesicles. In conclusion, sperm are not normally present within the seminal vesicles and ejaculatory duct obstruction should be suspected in any patient with numerous sperm within the seminal vesicles.