Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction

In this study, 8 patients were diagnosed as having ejaculatory duct obstruction. The complaints included infertility, painful ejaculation, hematospermia, and perineal and/or testicular pain. Preoperative diagnostics included transrectal ultrasonic scanning and magnetic resonance imaging. A body coil and an endorectal coil using fast spin-echo techniques were used. The diagnosis of ejaculatory duct obstruction in each patient was confirmed by vasography with a combined iodinated contrast medium and methylene blue solution for radiological and direct visualization. A resectoscope was used for careful unroofing of the involved ejaculatory duct orifice. Patency was confirmed radiographically and by direct vision. In terms of presenting complaints, 7 of 8 patients improved symptomatically and/or objectively. Ejaculatory duct obstruction, a more prevalent condition than is currently appreciated, should be thoroughly investigated and actively treated in cases of infertility or complaints referable to ejaculatory dysfunction. Magnetic resonance imaging using an endorectal coil is a valuable adjunct in the diagnosis and therapy of this disorder.