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Jonathan P Jarow - One of the best experts on this subject based on the ideXlab platform.

  • a prospective comparison of 3 diagnostic methods to evaluate Ejaculatory Duct Obstruction commentary
    The Journal of Urology, 2004
    Co-Authors: Rajveer S. Purohit, Jonathan P Jarow, Katsuto Shinohara, Paul J. Turek, Wayne J.g. Hellstrom, Jon L Pryor
    Abstract:

    Purpose: Various diagnostic tests are available to evaluate patients with Ejaculatory Duct Obstruction (EDO). However, the most accurate diagnostic technique, defined as the one that best predicts a successful outcome after Ejaculatory Duct resection, is unclear. We prospectively performed transrectal ultrasound (TRUS) and 3 other tests in men with EDO and determined their relative value in this diagnosis. Materials and Methods: Patients with suspected EDO on clinical evaluation that included TRUS proceeded to further intraoperative evaluation with Duct chromotubation, seminal vesicle aspiration and seminal vesiculography. A comparative analysis of findings from each technique was performed and the success of subsequent transurethral resection procedures was assessed. Results: All 25 patients had evidence of EDO on diagnostic TRUS, a finding that merited further evaluation with other modalities. However, TRUS findings correlated poorly with those of the other diagnostic tests. Obstruction on TRUS was confirmed in only 52%, 48% and 36% of vesiculography, seminal vesicle aspiration and Duct chromotubation studies, respectively. A better correlation was observed between the dynamic tests of Duct chromotubation and seminal vesiculography. Based on all diagnostic tests only 12 patients (48%) proceeded to Duct resection, of whom 10 (83%) showed significant improvement in semen analysis parameters or clinical symptoms after the procedure. Conclusions: A comparative analysis of 4 diagnostic techniques suggests that TRUS alone has poor specificity for EDO evaluation. Incorporating dynamic tests into the algorithm of EDO diagnosis may decrease unnecessary Duct resection procedures and improve the success of the resection procedures that are indicated.

  • Diagnosis and management of Ejaculatory Duct Obstruction.
    Zhonghua nan ke xue = National journal of andrology, 2002
    Co-Authors: Jonathan P Jarow
    Abstract:

    Ejaculatory Duct Obstruction is a rare but important cause of male infertility. The differential diagnosis, evaluation and treatment of patients with suspected Ejaculatory Duct Obstruction is described herein. New minimally invasive techniques that can be utilized in both the diagnosis and treatment of Ejaculatory Duct Obstruction are described.

  • Partial Ejaculatory Duct Obstruction Causing Early Demise of Sperm
    Urology, 1998
    Co-Authors: Jay C. Beiswanger, Jeffrey L. Deaton, Jonathan P Jarow
    Abstract:

    We report a case of partial Ejaculatory Duct Obstruction secondary to a mullerian Duct cyst presenting with failure to fertilize and early demise of sperm during in vitro fertilization.

  • Diagnosis and management of Ejaculatory Duct Obstruction.
    Techniques in urology, 1996
    Co-Authors: Jonathan P Jarow
    Abstract:

    Ejaculatory Duct Obstruction is a rare but correctable cause of male infertility. Complete Ejaculatory Duct Obstruction may be diagnosed by transrectal ultrasonography and the presence of numerous sperm within the seminal vesicles of an azoospermic patient. Partial Ejaculatory Duct Obstruction is difficult to document and therapy of this disorder should be considered investigational.

  • Transrectal ultrasonography in the diagnosis and management of Ejaculatory Duct Obstruction.
    Journal of andrology, 1996
    Co-Authors: Jonathan P Jarow
    Abstract:

    Ejaculatory Duct Obstruction is a rare but treatable cause of male infertility. The most common etiologies include congenital anomalies of the wolffian and Mullerian Ducts, trauma, and inflammation. The diagnosis of Ejaculatory Duct Obstruction should be suspected in any azoospermic patient with low ejaculate volume. Transrectal ultrasonography is now the preferred imaging modality for these patients. Seminal vesicle aspiration documents the presence of Obstruction, confirms the presence of intact spermatogenesis, and rules out more proximal Obstruction. Seminal vesiculography provides important anatomic information that may be helpful in determining the best method of treatment. It is a useful adjunct during transurethral resection of the Ejaculatory Ducts. Transurethral resection of the Ejaculatory Ducts is the standard method of treatment for Ejaculatory Duct Obstruction, but balloon dilation may be preferred in select patients with an extraprostatic Obstruction of the Ejaculatory Ducts. The exact criteria for the diagnosis of partial Ejaculatory Duct Obstruction are still unclear, and therapy for these patients should be considered investigational at this time.

Paul J. Turek - One of the best experts on this subject based on the ideXlab platform.

  • Ejaculatory Duct manometry in normal men and in patients with Ejaculatory Duct Obstruction
    The Journal of Urology, 2008
    Co-Authors: Michael L. Eisenberg, Thomas J. Walsh, Maurice M. Garcia, Katsuto Shinohara, Paul J. Turek
    Abstract:

    Purpose: Ejaculatory Duct Obstruction is a treatable cause of male infertility but the diagnosis can be difficult to make. Transrectal ultrasound is valuable but not specific for Ejaculatory Duct Obstruction. Adjunctive procedures, such as chromotubation and seminal vesicle aspiration, are more sensitive but not definitive, especially for partial Obstruction. We describe what is to our knowledge a new hydraulic test and report its ability to identify physical and functional Ejaculatory Duct Obstruction.Materials and Methods: Two groups of men were studied, including patients with infertility or Ejaculatory pain in whom Ejaculatory Duct Obstruction was suspected and fertile men undergoing vasectomy reversal (controls). In each cohort Ejaculatory Duct injection and manometry were performed. Patients with Ejaculatory Duct Obstruction underwent transurethral Ejaculatory Duct resection based on routine criteria. Pressure was reassessed after resection. Manometry pressures were compared between controls and pat...

  • Ejaculatory Duct Manometry in Normal Men and in Patients With Ejaculatory Duct Obstruction
    The Journal of urology, 2008
    Co-Authors: Michael L. Eisenberg, Thomas J. Walsh, Maurice M. Garcia, Katsuto Shinohara, Paul J. Turek
    Abstract:

    Ejaculatory Duct Obstruction is a treatable cause of male infertility but the diagnosis can be difficult to make. Transrectal ultrasound is valuable but not specific for Ejaculatory Duct Obstruction. Adjunctive procedures, such as chromotubation and seminal vesicle aspiration, are more sensitive but not definitive, especially for partial Obstruction. We describe what is to our knowledge a new hydraulic test and report its ability to identify physical and functional Ejaculatory Duct Obstruction. Two groups of men were studied, including patients with infertility or Ejaculatory pain in whom Ejaculatory Duct Obstruction was suspected and fertile men undergoing vasectomy reversal (controls). In each cohort Ejaculatory Duct injection and manometry were performed. Patients with Ejaculatory Duct Obstruction underwent transurethral Ejaculatory Duct resection based on routine criteria. Pressure was reassessed after resection. Manometry pressures were compared between controls and patients with Ejaculatory Duct Obstruction, and correlated with the response to transurethral Ejaculatory Duct resection. In the 7 controls (14 sides) mean Ejaculatory Duct opening pressure was 33.2 cm H(2)O. In the 9 patients (17 sides) with suspected Ejaculatory Duct Obstruction mean Ejaculatory Duct opening pressure before transurethral Ejaculatory Duct resection was 116 cm H(2)O. In the 6 patients who underwent resection, which was unilateral and bilateral in 3 each, mean Ejaculatory Duct opening pressure decreased from 118 to 53 cm H(2)O. Of the 5 patients who underwent semen analyses before and after resection 80% showed an increase in ejaculate volume and/or at least 100% improvement in TMC (volume x concentration x motile fraction). Ejaculatory Duct manometry with baseline values defined in fertile men demonstrates that men with clinically suspected Ejaculatory Duct Obstruction have higher Ejaculatory Duct opening pressure than fertile men and Ejaculatory Duct pressure decreases after transurethral Ejaculatory Duct resection.

  • Ejaculatory Duct Obstruction.
    The Urologic clinics of North America, 2008
    Co-Authors: James F. Smith, Thomas J. Walsh, Paul J. Turek
    Abstract:

    Ejaculatory Duct Obstruction presents with infertility, pain, or hematospermia. Partial or functional forms of Ejaculatory Duct Obstruction can be difficult to diagnose. Transrectal ultrasound has replaced formal vasography as the first-line diagnostic test but is not specific. Adjunctive procedures such as seminal vesicle aspiration, seminal vesiculography, and chromotubation further delineate the diagnosis. Using an evidence-based approach, this article reviews how best to approach the diagnosis and treatment of Ejaculatory Duct Obstruction.

  • A Prospective Comparison of 3 Diagnostic Methods to Evaluate Ejaculatory Duct Obstruction
    The Journal of urology, 2004
    Co-Authors: Rajveer S. Purohit, Katsuto Shinohara, Paul J. Turek
    Abstract:

    ABSTRACTPurpose: Various diagnostic tests are available to evaluate patients with Ejaculatory Duct Obstruction (EDO). However, the most accurate diagnostic technique, defined as the one that best predicts a successful outcome after Ejaculatory Duct resection, is unclear. We prospectively performed transrectal ultrasound (TRUS) and 3 other tests in men with EDO and determined their relative value in this diagnosis.Materials and Methods: Patients with suspected EDO on clinical evaluation that included TRUS proceeded to further intraoperative evaluation with Duct chromotubation, seminal vesicle aspiration and seminal vesiculography. A comparative analysis of findings from each technique was performed and the success of subsequent transurethral resection procedures was assessed.Results: All 25 patients had evidence of EDO on diagnostic TRUS, a finding that merited further evaluation with other modalities. However, TRUS findings correlated poorly with those of the other diagnostic tests. Obstruction on TRUS wa...

  • a prospective comparison of 3 diagnostic methods to evaluate Ejaculatory Duct Obstruction commentary
    The Journal of Urology, 2004
    Co-Authors: Rajveer S. Purohit, Jonathan P Jarow, Katsuto Shinohara, Paul J. Turek, Wayne J.g. Hellstrom, Jon L Pryor
    Abstract:

    Purpose: Various diagnostic tests are available to evaluate patients with Ejaculatory Duct Obstruction (EDO). However, the most accurate diagnostic technique, defined as the one that best predicts a successful outcome after Ejaculatory Duct resection, is unclear. We prospectively performed transrectal ultrasound (TRUS) and 3 other tests in men with EDO and determined their relative value in this diagnosis. Materials and Methods: Patients with suspected EDO on clinical evaluation that included TRUS proceeded to further intraoperative evaluation with Duct chromotubation, seminal vesicle aspiration and seminal vesiculography. A comparative analysis of findings from each technique was performed and the success of subsequent transurethral resection procedures was assessed. Results: All 25 patients had evidence of EDO on diagnostic TRUS, a finding that merited further evaluation with other modalities. However, TRUS findings correlated poorly with those of the other diagnostic tests. Obstruction on TRUS was confirmed in only 52%, 48% and 36% of vesiculography, seminal vesicle aspiration and Duct chromotubation studies, respectively. A better correlation was observed between the dynamic tests of Duct chromotubation and seminal vesiculography. Based on all diagnostic tests only 12 patients (48%) proceeded to Duct resection, of whom 10 (83%) showed significant improvement in semen analysis parameters or clinical symptoms after the procedure. Conclusions: A comparative analysis of 4 diagnostic techniques suggests that TRUS alone has poor specificity for EDO evaluation. Incorporating dynamic tests into the algorithm of EDO diagnosis may decrease unnecessary Duct resection procedures and improve the success of the resection procedures that are indicated.

Larry I. Lipshultz - One of the best experts on this subject based on the ideXlab platform.

  • Transurethral resection of the Ejaculatory Ducts: etiology of Obstruction and surgical treatment options
    Fertility and sterility, 2019
    Co-Authors: Gabriella J. Avellino, Larry I. Lipshultz, Mark Sigman, Kathleen Hwang
    Abstract:

    Ejaculatory Duct Obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the Ejaculatory Ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with Ejaculatory Duct Obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of Ejaculatory Duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of Obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.

  • semen parameters before and after transurethral surgery for Ejaculatory Duct Obstruction
    The Journal of Urology, 1996
    Co-Authors: Paul J. Turek, Jorge O Magana, Larry I. Lipshultz
    Abstract:

    AbstractPurpose: We examined how transurethral resection of the Ejaculatory Ducts, performed for infertility, affects semen quality in patients with azoospermia and oligo-asthenospermia.Materials and Methods: A retrospective review was done of 46 cases of transurethral resection of the Ejaculatory Ducts for Ejaculatory Duct Obstruction, confirmed by transrectal ultrasound. Clinical course and semen quality were assessed by semen parameter indications.Results: In 65 percent of the patients transurethral resection of the Ejaculatory Ducts improved semen quality (greater than a 50 percent increase in total motile sperm count) and 20 percent initiated a pregnancy an average of 6.1 months postoperatively. Statistically significant increases in total motile sperm count were achieved in men with azoospermia and those treated for oligo-asthenospermic indications; the improvement also was shown to be sustainable. Complications occurred in 20 percent of the men.Conclusions: Significant and durable semen quality imp...

  • Semen Parameters Before and After Transurethral Surgery for Ejaculatory Duct Obstruction
    The Journal of urology, 1996
    Co-Authors: Paul J. Turek, Jorge O Magana, Larry I. Lipshultz
    Abstract:

    We examined how transurethral resection of the Ejaculatory Ducts, performed for infertility, affects semen quality in patients with azoospermia and oligo-asthenospermia. A retrospective review was done of 46 cases of transurethral resection of the Ejaculatory Ducts for Ejaculatory Duct Obstruction, confirmed by transrectal ultrasound. Clinical course and semen quality were assessed by semen parameter indications. In 65% of the patients transurethral resection of the Ejaculatory Ducts improved semen quality (greater than a 50% increase in total motile sperm count) and 20% initiated a pregnancy an average of 6.1 months postoperatively. Statistically significant increases in total motile sperm count were achieved in men with azoospermia and those treated for oligo-asthenospermic indications; the improvement also was shown to be sustainable. Complications occurred in 20% of the men. Significant and durable semen quality improvement can be achieved after transurethral resection of the Ejaculatory Ducts for all surgical indications. In most unsuccessful cases the reason for failure is unclear.

  • Role of ultrasound in the assessment of male infertility.
    Journal of clinical ultrasound : JCU, 1996
    Co-Authors: Edward D. Kim, Larry I. Lipshultz
    Abstract:

    The use of ultrasonography has become an important component in the evaluation and treatment of male reproDuctive tract disorders. From the use of color flow Doppler ultrasonography for the assessment of varicoceles to transrectal ultrasonography combined with seminal vesiculography for the evaluation of Ejaculatory Duct Obstruction, ultrasonography has practical clinical applications. In this article, the authors review the indications and use of ultrasonography in the assessment and treatment of the infertile male. The recent advances in diagnostic transrectal ultrasonography for Ejaculatory Duct Obstruction, in particular, are emphasized.

  • Transrectal ultrasound and partial Ejaculatory Duct Obstruction in male infertility.
    Urology, 1992
    Co-Authors: Daniel K. Hellerstein, Randall B. Meacham, Larry I. Lipshultz
    Abstract:

    Partial Ejaculatory Duct Obstruction, due to either a congenital or an acquired cyst or Ejaculatory Duct stenosis secondary to calcification, chronic inflammation, can produce a wide spectrum of seminal fluid abnormalities. Sperm density may range from azoospermia to normospermia while ejaculate volume can be low to normal. Sperm motility is consistently diminished (less than 30%). We have treated 2 patients with Ejaculatory Duct stenosis whose diagnosis was accurately made with transrectal ultrasonography (TRUS). We now suggest that TRUS be used when there is a low semen volume (less than 1.0 cc), or low motility (less than 30%), or oligospermia (less than 20 million sperm/mL), and normal findings on physical examination with normal serum gonadotropin values in the absence of any other explanation.

Ates Kadioglu - One of the best experts on this subject based on the ideXlab platform.

  • comparison of transrectal ultrasonography and transrectal ultrasonography guided seminal vesicle aspiration in the diagnosis of the Ejaculatory Duct Obstruction
    Fertility and Sterility, 2009
    Co-Authors: Gülgün Engin, Murat Celtik, Oner Sanli, Omer Aytac, Zarifcan Muradov, Ates Kadioglu
    Abstract:

    Objective To compare transrectal ultrasonography (TRUS) and TRUS-guided seminal vesicle aspiration in the diagnosis of Ejaculatory Duct Obstruction (EDO). Design A retrospective case-controlled study comparing the findings of TRUS and TRUS-guided seminal vesicle (SV) aspiration. Setting Clinics of Urology and Radiology. Patient(s) Seventy patients with suspected EDO (complete in 10, partial in 60 patients) on clinical evaluation. Intervention(s) Each SV was punctured transrectally using a 20-gauge Chiba needle within 2 hours after ejaculation. Main outcome measure(s) In SV aspirates, greater than three sperm per high-power microscopic field was considered a positive result for EDO. Result(s) Fifty-five (78.6%) patients had evidence of EDO on diagnostic TRUS. However, Obstruction on TRUS was confirmed in 49.1% (27 of 55) of the patients with SV aspiration. Higher sperm positivity rates were achieved in patients with SV dilation (11 of 13, 84.6%) and prostatic midline/ED cyst (12 of 16, 75.0%). Stepwise logistic regression analysis revealed that the incidence of SV dilation was significantly higher, whereas that of chronic inflammatory findings in the prostate was significantly lower in the positive SV aspirate group. Conclusion(s) TRUS alone is not a reliable tool for the diagnosis of EDO. For this reason, SV aspiration should be used as an adjunctive technique in patients with SV dilation or a prostatic midline/ED cyst to confirm the diagnosis before surgery.

  • technetium tc 99m sulphur colloid seminal vesicle scintigraphy a novel approach for the diagnosis of the Ejaculatory Duct Obstruction
    Urology, 2008
    Co-Authors: İrfan Orhan, Rahmi Onur, Imed Duksal, Tansel Ansal Balci, Kursad Poyraz, Fatih Firdolas, Ates Kadioglu
    Abstract:

    Objectives To define a novel technique in the diagnosis of partial and complete Ejaculatory Duct Obstruction (EDO). Methods Twenty men with suspected EDO were initially evaluated by transrectal ultrasound (TRUS). Subsequently, all patients underwent TRUS-guided seminal vesicle (SV) scintigraphy. Technetium Tc 99m sulphur colloid solution was injected into each SV under TRUS guidance and patients were immediately evaluated by scintigraphy. After patients ejaculated scintigraphy was repeated. The difference between 2 measurements in respect to technetium Tc 99m count was used to measure the percentage of emptying. Results In the first group, TRUS revealed 11 patients with findings suggestive of EDO, whereas no abnormality was found in 9. Scintigraphic measurement in first group of patients showed a mean emptying ratio for the right and left SVs of 16.6% ± 2.22 (2.2 to 30.6) and 17.1% ± 2.34 (1.4 to 32.5), respectively. The mean percent of emptied technetium Tc 99m from right and left SVs in patients with no pathologic findings on TRUS was 30.9% ± 4.3 (10.1 to 44.2) and 33.9% ± 5.81 (13.6 to 68.1), respectively. Statistically significant difference was determined between 2 groups ( P = 0.037). Initially, TRUS examination revealed no pathologic findings in 3 patients; however, SV scintigraphy showed less than 30% emptying and revealed an additional 33% of patients to be obstructed in our series. Conclusions TRUS, the static anatomic imaging modality, may not be sufficient to distinguish functional from complete Obstruction. Seminal vesicle scintigraphy is unique that incorporates physiologic aspect of ejaculation into a diagnostic intervention, of which we believe that is especially important in diagnosis of functional EDO.

  • Does response to treatment of Ejaculatory Duct Obstruction in infertile men vary with pathology
    Fertility and sterility, 2001
    Co-Authors: Ates Kadioglu, Gülgün Engin, Selahittin Çayan, Ahmet Tefekli, İrfan Orhan, Paul J. Turek
    Abstract:

    Abstract Objective: To describe the pathology-specific response to transurethral resection of Ejaculatory Ducts (TURED) in patients with complete or partial Ejaculatory Duct Obstruction and to evaluate the role of TURED in light of powerful assisted reproDuctive technologies. Design: Retrospective clinical study. Setting: University hospital. Patient(s): Thirty-eight infertile men with Obstruction of the Ejaculatory Ducts. Intervention(s): Diagnosis by transrectal ultrasonography or magnetic resonance imaging, and treatment with TURED. Main Outcome Measure(s): Changes in semen variables, pregnancy outcomes, and complication rates were analyzed before and after surgery. Result(s): Improvement in semen variables was significantly better in patients with partial Obstruction (94%) of Ducts than in those with complete Obstruction (59%) ( P =.04). Cystic Obstruction, especially midline and eccentric cysts, responded best to TURED. Before surgery, all patients were candidates for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospermic men conceived spontaneously or were referred for IUI instead of IVF/ICSI. Conclusion(s): Ejaculatory Duct Obstruction due to cysts appears to respond best to TURED. In addition, TURED may decrease the need for IVF/ICSI as primary treatment in many cases. Finally, TURED may allow IVF/ICSI to be performed with ejaculated rather than surgically retrieved sperm.

Asif Muneer - One of the best experts on this subject based on the ideXlab platform.

  • A systematic review of transurethral resection of Ejaculatory Ducts for the management of Ejaculatory Duct Obstruction.
    Turkish journal of urology, 2020
    Co-Authors: Ayah Mekhaimar, David J. Ralph, Asif Muneer, Mary Goble, Oliver Brunckhorst, Hussain M. Alnajjar, Kamran Ahmed
    Abstract:

    OBJECTIVE Ejaculatory Duct Obstruction (EDO) is an uncommon but potentially treatable cause of male factor infertility. However, there are limited data on transurethral resection of the Ejaculatory Ducts (TURED) as a treatment option. A systematic review was therefore conDucted to assess its efficacy and identify patient subgroups that benefit from the procedure. MATERIAL AND METHODS A database search of PubMed, Embase, and Scopus (up to January 2019) and the World Health Organization trial registry was performed to identify all studies assessing infertile men with EDO undergoing TURED. The primary outcome measures included semen parameters and natural pregnancies. The secondary outcomes included complications, symptomatic improvement, and a change from in vitro fertilization to intrauterine insemination. RESULTS Of 3,277 articles screened, 29 studies with 634 patients were included in the study. Although outcomes varied considerably among studies, a general increase in all semen parameters postoperatively was observed. Semen volume (n=23 studies) improved in a median of 83.0% of patients (interquartile range [IQR]: 37.5). Sperm motility and concentration (n=10 and n=21 studies) improved in a median of 63.0% (IQR: 15.0) and 62.5% (IQR: 16.5) of patients, respectively. The natural pregnancy rate across the studies was a median of 25.0% (IQR: 15.7). Improvements in both the outcomes were greater in patients with congenital etiologies and partial EDO. Differences in surgical technique did not appear to affect outcomes. CONCLUSION TURED is associated with improvements in semen parameters and offers a chance of restoring fertility in previously subfertile men. Although results are promising, the current evidence remains limited owing to predominantly retrospective studies with small sample sizes.

  • An update on the diagnosis and management of Ejaculatory Duct Obstruction
    Nature Reviews Urology, 2016
    Co-Authors: Vaibhav Modgil, Sonpreet Rai, David J. Ralph, Asif Muneer
    Abstract:

    Ejaculatory Duct Obstruction (EDO) remains a rare but surgically correctable cause of male sexual dysfunction and male infertility due to obstructive azoospermia, diagnosed in up to 5% of infertile men. EDO should, therefore, be considered within the list of differential diagnoses for men undergoing infertility investigations, with work up including clinical examination, transurethral ultrasonography, semen analysis, chromotubation, seminal vesiculography and seminal vesicle aspiration. Obstruction can be limited to the distal ends of the Ducts or it can extend proximally to include the terminal portions of the vasa deferentia, with the site and length of the Obstruction having implications for surgical intervention. Early endoscopic treatment can reverse symptoms and prevent the progression of partial Obstruction to bilateral, complete Obstruction, and transurethral resection of the Ejaculatory Duct remains the main treatment option for EDO. Alternative treatment options include endoscopic laser-assisted resection of the Ducts, antegrade seminal-vesicle lavage to relieve EDO secondary to inspissated material or calculi, or dilatation of the Ejaculatory Ducts using 9F seminal vesicoscopy or balloon. Ejaculatory Duct Obstruction (EDO) is a surgically reversible cause of male factor infertility, diagnosed in 1–5% of infertile men EDO should be considered in the differential diagnosis of men presenting with nonspecific complaints related to sexual dysfunction such as periEjaculatory pain, low volume ejaculate and haematospermia Congenital causes of EDO include congenital atresia or stenosis of the Ejaculatory Ducts and Müllerian Duct (utricular) or Wolffian Duct (diverticular) cysts The work-up of men presenting with possible EDO includes clinical examination, transurethral ultrasonography, semen analysis, chromotubation, seminal vesiculography and seminal vesicle aspiration Transurethral resection of Ejaculatory Ducts (TURED) remains the mainstay of treatment for EDO; complications after TURED occur in approximately 13–26% of patients Although rare, Ejaculatory Duct Obstruction (EDO) is a surgically correctable cause of male sexual dysfunction and male infertility due to obstructive azoospermia, and should be considered within the list of differential diagnoses for men undergoing infertility investigations. In this article, the authors discuss the anatomy, embryology and pathophysiology of EDO, and consider the current optimal diagnostic and treatment options.

  • An update on the diagnosis and management of Ejaculatory Duct Obstruction
    Nature reviews. Urology, 2015
    Co-Authors: Vaibhav Modgil, Sonpreet Rai, David J. Ralph, Asif Muneer
    Abstract:

    Ejaculatory Duct Obstruction (EDO) remains a rare but surgically correctable cause of male sexual dysfunction and male infertility due to obstructive azoospermia, diagnosed in up to 5% of infertile men. EDO should, therefore, be considered within the list of differential diagnoses for men undergoing infertility investigations, with work up including clinical examination, transurethral ultrasonography, semen analysis, chromotubation, seminal vesiculography and seminal vesicle aspiration. Obstruction can be limited to the distal ends of the Ducts or it can extend proximally to include the terminal portions of the vasa deferentia, with the site and length of the Obstruction having implications for surgical intervention. Early endoscopic treatment can reverse symptoms and prevent the progression of partial Obstruction to bilateral, complete Obstruction, and transurethral resection of the Ejaculatory Duct remains the main treatment option for EDO. Alternative treatment options include endoscopic laser-assisted resection of the Ducts, antegrade seminal-vesicle lavage to relieve EDO secondary to inspissated material or calculi, or dilatation of the Ejaculatory Ducts using 9F seminal vesicoscopy or balloon.