Transrectal ultrasound in male infertility

In the evaluation of the subfertile man who has severe oligospermia or azoospermia associated with a low volume ejaculate, the high resolution transrectal ultrasound (TRUS) has, in recent years, been a very important non-invasive imaging technique to detect abnormalities in the seminal vesicles, ejaculatory duct and the status of the prostate. We performed TRUS in 30 of these patients from January to December 1994 followed by scrotal exploration with vasogram using methylene blue, inspection of the epdidymis for dilatation and fibrosis together with testicular biopsy to evaluate testicular spermatogenesis and obstruction. Of the 30 patients, 11 were found to have dilated vesicles or ejaculatory duct obstruction. Three had features of prostatitis with calcification or thickened wall of the vesicles and one had an absent vesicle and vas. The remaining 15 patients had normal seminal vesicles and ejaculatory ducts on TRUS and their testicular biopsies showed atrophy, fibrosis or maturation arrest. Transurethral resection of the ejaculatory duct (TRU-ED) under TRUS guidance was done for 10 patients with dilated seminal vesicles and 6 of them had normal semen analysis 3 months after operation. Two successful pregnancies were achieved.