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

  • transrectal us guided seminal vesiculography and Ejaculatory Duct recanalization and balloon dilation for treatment of chronic pelvic pain
    Journal of Vascular and Interventional Radiology, 2006
    Co-Authors: Leo P Lawler, Jonathan P Jarow, Octavio Cosin, Hyun S Kim
    Abstract:

    Ejaculatory Duct obstruction (EDO) is an uncommon but correctable cause of infertility and male chronic pelvic pain. The condition is thought to be underdiagnosed, but the increased application of noninvasive imaging tools, specifically transrectal ultrasonography (US), has lead to greater recognition of EDO. Moreover, the development of minimally invasive therapies now offers comprehensive evaluation and treatment options with low morbidity for select patient groups. This report describes the technique of transrectal US–guided seminal vesiculography, percutaneous recanalization, and Ejaculatory Duct balloon dilation for EDO as a treatment for male chronic pelvic pain.

  • 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.

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.

Harry Fisch - One of the best experts on this subject based on the ideXlab platform.

  • Ejaculatory Duct dysfunction and lower urinary tract symptoms chronic prostatitis
    Current Urology Reports, 2010
    Co-Authors: Matthew Mcintyre, Harry Fisch
    Abstract:

    Chronic pelvic pain syndrome (CPPS) is the most prevalent form of prostatitis. It is characterized by pelvic pain, voiding symptoms, and Ejaculatory symptoms in the absence of bacterial infection. This can be a difficult condition to treat. Many etiologies for CPPS have been proposed including immunologic, neurologic, endocrine, and psychological factors. This article examines a potentially correctable condition that may lead to CPPS, Ejaculatory Duct obstruction (EDO). EDO is easily correctable with minor surgery. In patients with symptoms of CPPS with associated Ejaculatory pain, the diagnosis of EDO should strongly be considered.

  • Ejaculatory Duct dysfunction and chronic pelvic pain syndrome in men
    Current Prostate Reports, 2009
    Co-Authors: Harry Fisch
    Abstract:

    Chronic pelvic pain syndrome (CPPS) describes unexplained pelvic pain in men associated with irritative voiding symptoms, post-orgasmic pain, and/or pain located in the groin, genitalia, or perineum in the absence of bacterial infection. Many different etiologies of CPPS have been proposed, including roles for immunologic, neurologic, endocrine, and psychologic factors. This article examines one such factor—Ejaculatory Duct obstruction (EDO). Because EDO is correctable with relatively minor surgery, it should be considered by any clinician caring for a patient who reports symptoms of CPPS.

  • Management of Ejaculatory Duct obstruction: etiology, diagnosis, and treatment
    World Journal of Urology, 2006
    Co-Authors: Harry Fisch, Sarah M. Lambert, Erik T. Goluboff
    Abstract:

    Abnormalities of the distal Ejaculatory Ducts related to infertility have been well-documented. Although there are no specific findings associated with Ejaculatory Duct obstruction, several clinical findings are highly suggestive. A diagnosis of Ejaculatory Duct obstruction is suggested 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 TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of Ejaculatory Ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the Ejaculatory Ducts will continue to refine diagnostic and therapeutic procedures for this disorder.

  • Ejaculatory Duct obstruction.
    Current opinion in urology, 2002
    Co-Authors: Harry Fisch, Young M. Kang, Christopher W. Johnson, Erik T. Goluboff
    Abstract:

    Purpose of reviewWe surveyed the growing literature on Ejaculatory Duct obstruction and provide suggestions regarding its diagnosis and management.Recent findingsEjaculatory Duct obstruction is a rare cause of male infertility. With the advent of the high resolution transurethral ultrasound (TRUS) t

  • the natural history of partial Ejaculatory Duct obstruction
    The Journal of Urology, 2002
    Co-Authors: Harris M Nagler, Michael Rotman, Edward Zoltan, Harry Fisch
    Abstract:

    Ejaculatory Duct obstruction is a rare but treatable cause of male infertility. We report an unusual case of progression from partial to complete Ejaculatory Duct obstruction after therapeutic left varicocelectomy. CASE REPORT A 34-year-old man with no significant medical or surgical history presented for evaluation of primary infertility. The patient had normal sexual development and no history of trauma or genitourinary infection. Physical examination was only significant for slight testicular asymmetry and a grade 2 of 3 left varicocele. Semen analysis revealed a volume of 1.1 cc (normal greater than 2.0), 65.8 million sperm (normal greater than 40 million/cc), 35% motility (normal greater than 50%) and 10% normal forms (normal greater than 14%, Kruger strict criteria). A repeat semen analysis was similar. Post-Ejaculatory urine did not demonstrate any sperm. Endocrine profile was normal. Transrectal ultrasound demonstrated a right seminal vesicle measuring 1.4 cm. anteroposteriorly, which is the upper limit of normal (fig. 1) and a left seminal vesicle that measured 1.1 cm. anteroposteriorly. Figure 2 shows the area of possible obstruction of the Ejaculatory Ducts. Treatment options included transurethral resection of the Ejaculatory Ducts, microsurgical varicocelectomy or assisted reproDuctive techniques. The patient chose to undergo left microsurgical varicocelectomy. The varicocele resolved postoperatively. Postoperative semen analysis demonstrated azoospermia (volume 0.9 cc, fructose barely positive), which was confirmed on repeat analysis. Repeat transrectal ultrasound was similar to the initial study. Transurethral resection of the Ejaculatory Ducts was performed and pathological

Jesse K Mckenney - One of the best experts on this subject based on the ideXlab platform.

  • the distribution of pax 2 immunoreactivity in the prostate gland seminal vesicle and Ejaculatory Duct comparison with prostatic adenocarcinoma and discussion of prostatic zonal embryogenesis
    Human Pathology, 2010
    Co-Authors: Charles M Quick, Neriman Gokden, Ankur R Sangoi, James D Brooks, Jesse K Mckenney
    Abstract:

    PAX-2 is a homeogene strongly expressed during development of the genitourinary tract, including the kidney and both wolffian- and mullerian-derived tissues. Expression of PAX-2 by immunohistochemistry has been studied mainly in renal epithelial neoplasms with little attention to the lower male genitourinary tract. We studied PAX-2 expression in epithelium of normal seminal vesicle, normal Ejaculatory Duct, normal prostatic secretory epithelium, and prostatic adenocarcinoma to define its immunoreactivity pattern throughout the prostate gland and to evaluate its potential diagnostic role in the discrimination of seminal vesicle/Ejaculatory Duct epithelium from prostatic adenocarcinoma. In addition, given that PAX-2 is highly expressed in tissues of wolffian Duct embryologic origin, we also sought to confirm the divergent embryogenesis of the central zone, seminal vesicle, and Ejaculatory Duct from other regions of the prostate. Prostatectomy specimens from 12 patients were reviewed to identify blocks containing seminal vesicle, Ejaculatory Duct, periurethral glands, benign prostatic glands, and prostatic acinar adenocarcinoma. A total of 35 blocks from the 12 patients were evaluated. In addition, 2 tissue microarrays representing 15 additional seminal vesicles and 45 prostatic adenocarcinomas, 7 whole sections from prostatic adenocarcinomas of the central zone, and 5 core needle biopsies of seminal vesicle were also evaluated with anti-PAX-2 antibody. In the 12 radical prostatectomy whole sections, nuclear reactivity for PAX-2 was identified in 12 (100%) of 12 of the seminal vesicle epithelium, 9 (90%) of 10 of the Ejaculatory Duct epithelium, 0 of 12 of the prostatic adenocarcinoma, and 0 of 6 of the high-grade prostatic intraepithelial neoplasia. All 20 total additional seminal vesicles were positive for PAX-2 in the tissue microarray and biopsies; and all 52 additional prostatic adenocarcinomas were negative, including 7 of central zone origin. The staining intensity and percentage of immunoreactive cells in seminal vesicle were both 3+ in all cases. Although the Ejaculatory Ducts also showed diffuse staining, their staining intensity was less (2+) than that in the seminal vesicles, particularly in the Ejaculatory Ducts in the periurethral area (1-2+intensity). The smaller glands surrounding the main seminal vesicle Duct also showed less intense staining than the luminal cells of the main Duct. Of the 19 total cases with evaluable central zone glands, 2 (10.5%) had focal nuclear reactivity in normal, benign prostatic secretory cells. All other benign prostatic secretory epithelia from the peripheral and transition zones were negative for PAX-2. In conclusion, nuclear PAX-2 immunoreactivity is typical in epithelium of the seminal vesicle and Ejaculatory Duct; but the intensity of staining is less in the Ejaculatory Duct. No reactivity for PAX-2 was seen in prostatic adenocarcinoma or high-grade prostatic intraepithelial neoplasia. PAX-2 has diagnostic utility as a positive immunohistochemical marker of seminal vesicle and Ejaculatory Duct epithelium. In addition, these data add further support to the proposed embryogenesis of the prostatic central zone, seminal vesicle, and Ejaculatory Ducts from the wolffian system.

Katsuto Shinohara - 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.

  • 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.