Endoscopic management of ejaculatory duct obstruction

Area of Science:

• Urology
• Reproductive Medicine
• Surgical Innovation

Background:

• Azoospermia, the absence of sperm in ejaculate, affects male fertility.
• Ejaculatory duct obstruction (EDO) is a treatable cause of obstructive azoospermia.
• Accurate diagnosis of EDO requires a combination of clinical, biochemical, and imaging findings.

Purpose of the Study:

• To evaluate the efficacy of endoscopic management for ejaculatory duct obstruction (EDO) in patients with azoospermia.
• To assess the success rates of surgical restoration of ejaculatory duct patency.
• To determine the subsequent fertility and pregnancy rates following treatment.

Main Methods:

• Retrospective evaluation of 191 patients for azoospermia, identifying 11 with EDO.
• Diagnostic criteria included normal serum hormones, normal testicular biopsy, low ejaculate volume, absent seminal fructose, and transrectal ultrasound findings.
• Endoscopic resection and/or incision of the ejaculatory duct ostium, with intraoperative patency confirmation using methylene blue dye.

Main Results:

• Endoscopic treatment was performed on all 11 patients diagnosed with EDO.
• Intraoperative patency was achieved in 10 patients (91%).
• Postoperative patency was confirmed in 7 patients (70%), with 2 patients (20%) achieving conception within 2 years.

Conclusions:

• Endoscopic management is an effective treatment for ejaculatory duct obstruction causing azoospermia.
• The procedure offers a viable option for restoring fertility in select male patients.
• Potential complications include urinary retention, hematuria, and epididymitis, necessitating careful patient selection and monitoring.