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01-12-2006 | Topic Paper

Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment

Authors: Harry Fisch, Sarah M. Lambert, Erik T. Goluboff

Published in: World Journal of Urology | Issue 6/2006

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.

Belker AM, Bennett AH (1988) Applications of microsurgery in urology. Surg Clin North Am 68:1157–1178PubMed

Meacham RB, Hellerstein DK, Lipshultz LI (1993) Evaluation and treatment of ejaculatory duct obstruction in the infertile male. Fertil Steril 59:393–397PubMed

Carter SS, Shinohara K, Lipshultz LI (1989) Transrectal ultrasonography in disorders of the seminal vesicles and ejaculatory ducts. Urol Clin North Am 16:773–790PubMed

Hellerstein DK, Meacham RB, Lipshultz LI (1992) Transrectal ultrasound and partial ejaculatory duct obstruction in male infertility. Urology 39:449–452CrossRefPubMed

Weintraub MP, De Mouy E, Hellstrom WJ (1993) Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction. J Urol 150:1150–1154PubMed

Nagler HM, Rotman M, Zoltan E, Fisch H (2002) The natural history of partial ejaculatory duct obstruction. J Urol 167:253–254CrossRefPubMed

Sun GH, Lee SS, Yu DS, Chen HI, Chang SY (2000) Successful treatment of azoospermia secondary to ejaculatory duct cyst. Arch Androl 45:25–28CrossRefPubMed

Schroeder-Printzen I, Ludwig M, Kohn F, Weidner W (2000) Surgical therapy in infertile men with ejaculatory duct obstruction: technique and outcome of a standardized surgical approach. Hum Reprod 15:1364–1368CrossRefPubMed

Paick JS (2000) Transurethral resection of the ejaculatory duct. Int J Urol 7(Suppl):S42–S47CrossRefPubMed

10.

Fisch H (1992) Transurethral resection of the ejaculatory ducts. Curr Surg Techn Urol 5(5):2–7

11.

Farley S, Barnes R (1973) Stenosis of ejaculatory ducts treated by endoscopic resection. J Urol 109:664–666PubMed

12.

Carson CC (1984) Transurethral resection for ejaculatory duct stenosis and oligospermia. Fertil Steril 41:482–484PubMed

13.

Pryor JP, Hendry WF (1991) Ejaculatory duct obstruction in subfertile males: analysis of 87 patients. Fertil Steril 56:725–730PubMed

14.

Belker AM, Steinbock GS (1990) Transrectal prostate ultrasonography as a diagnostic and therapeutic aid for ejaculatory duct obstruction. J Urol 144:356–358PubMed

15.

Goldwasser BZ, Weinerth JL, Carson CC 3d (1985) Ejaculatory duct obstruction: the case for aggressive diagnosis and treatment. J Urol 134:964–966PubMed

16.

Jarow JP (1993) Transrectal ultrasonography of infertile men. Fertil Steril 60:1035–1039PubMed

17.

Worischeck JH, Parra RO (1993) Transrectal ultrasound in the evaluation of men with low volume azoospermia. J Urol 149:1341–1344PubMed

18.

Shabsigh R, Lerner S, Fishman IJ, Kadmon D (1989) The role of transrectal ultrasonography in the diagnosis and management of prostatic and seminal vesicle cysts. J Urol 141:1206–1209PubMed

19.

Porch PP Jr (1978) Aspermia owing to obstruction of distal ejaculatory duct and treatment by transurethral resection. J Urol 119:141–142PubMed

20.

Kadioglu A, Cayan S, Tefekli A, Orhan I, Engin G, Turek PJ (2001) Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology? Fertil Steril 76:138–142CrossRefPubMed

21.

Sadler TW (1985) LangmanÆs medical embryology. Williams & Wilkins, Baltimore, pp 247–280

22.

McCarthy JF, Ritter S, Klemperer P (1924) Anatomical Anatomical and histological study of the verumontanum with especial reference to the ejaculatory ducts. J Urol 17:1–16

23.

McMahon S (1938) An anatomical study by injection technique of the ejaculatory ducts and their relations. J Urol 39:422–443

24.

Morgan RJ, Williams DI, Pryor JP (1979) Müllerian duct remnants in the male. Br J Urol 51:488–492PubMedCrossRef

25.

Mayersak JS (1989) Urogenital sinus-ejaculatory duct cyst: a case report with a proposed clinical classification and review of the literature. J Urol 142:1330–1332PubMed

26.

Stifelman MD, Tanaka K, Jones JG, Amin H, Fisch H (1993) Transurethral resection of ejaculatory ducts: anatomy and pathology (abstract O-117). Fertil Steril 60:S55–S56

27.

Schnall MD, Pollack HM, Van Arsdalen K, Kressel HY (1992) The seminal tract in patients with ejaculatory dysfunction: MR imaging with an endorectal surface coil. Am J Roentgenol 159:337–341

28.

Jirasek JE (1980) Normal development of the male accessory glands. In: Spring-Mills E, Hafez ESE (eds) Male accessory sex glands. Elsevier/North-Holland, New York, pp 3–16

29.

Weintraub CM (1980) Transurethral drainage of the seminal tract for obstruction, infection and infertility. Br J Urol 52:220–225PubMed

30.

Silber SJ (1980) Ejaculatory duct obstruction. J Urol 124:294–297PubMed

31.

Johnson CW, Bingham JB, Goluboff ET, Fisch H (2005) Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms. BJU Int 95:117–119CrossRefPubMed

32.

Takatera H, Sugao H, Sakurai T (1987) Ejaculatory duct cyst: the case for effective use of transrectal longitudinal ultrasonography. J Urol 137:1241–1242PubMed

33.

Patterson L, Jarow JP (1990) Transrectal ultrasonography in the evaluation of the infertile man: a report of three cases. J Urol 144:1469–1471PubMed

34.

Fuse H, Okumura A, Satomi S, Kazama T, Katayama T (1992) Evaluation of seminal-vesicle characteristics by ultrasonography before and after ejaculation. Urol Int 49:110–113PubMedCrossRef

35.

Katz D, Mieza M, Nagler HM (1994) Ultrasound guided transrectal seminal vesiculography: a new approach to the diagnosis of male reproductive tract abnormalities (abstract 330). J Urol 151:310A

36.

Jarow JP (1994) Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction. J Urol 152:899–901PubMed

37.

Orhan I, Onur R, Cayan S, Koksal IT, Kadioglu A (1999) Seminal vesicle sperm aspiration in the diagnosis of ejaculatory duct obstruction. BJU Int 84:1050–1053CrossRefPubMed

38.

Littrup PJ, Lee F, McLeary RD, Wu D, Lee A, Kumasaka GH (1988) Transrectal US of the seminal vesicles and ejaculatory ducts: clinical correlation. Radiology 168:625–628PubMed

39.

Wessels EC, Ohori M, Grantmyre JE, Aihara M, Gillespie RI, Garrett RW, Kassabian VS, Scardino PT, Lipshultz LI (1992) The prevalence of cystic dilatation of the ejaculatory ducts detected by transrectal ultrasound (TRUS) in a self-referred (screening) group of men (abstract 973). J Urol 147:456A

40.

Kirkali Z, Yigitbasi O, Diren B, Hekimoglu B, Ersoy H (1991) Cysts of the prostate, seminal vesicles and diverticulum of the ejaculatory ducts. Eur Urol 20:77–80PubMed

41.

Elder JS, Mostwin JL (1984) Cyst of the ejaculatory duct/urogenital sinus. J Urol 132:768–771PubMed

42.

Van Poppel H, Vereecken R, De Geeter P, Verduyn H (1983) Hemospermia owing to utricular cyst: embryological summary and surgical review. J Urol 129:608–609PubMed

43.

Malkevich DA, Mieza M, Nagler HM (1994) Patency of ejaculatory ducts after transurethral resection of ejaculatory ducts verified by reflux seen on voiding cystourethrogram (abstract 295). J Urol 151:301A

44.

Nagler HM, Vazquez-Levin MH, Dressler KP (1994) Urine contamination of seminal fluid after transurethral resection of the ejaculatory ducts (abstract 297). J Urol 151:302A

45.

Goluboff ET, Kaplan SA, Fisch H (1995) Seminal vesicle urinary reflux as a complication of transurethral resection of the ejaculatory ducts. J Urol 153:1234–1235CrossRefPubMed

46.

Turek PJ, Magana JO, Lipshultz LI (1996) Semen parameters before and after transurethral surgery for ejaculatory duct obstruction. J Urol 155:1291–1293CrossRefPubMed

47.

Netto NR, Esteves SC, Neves PA (1998) Transurethral resection of partially obstructed ejaculatory ducts: Seminal parameters and pregnancy outcomes according to the etiology of obstruction. J Urol 159:2048–2053CrossRefPubMed

48.

Colpi GM, Negri L, Patrizio P, Pardi G (1995) Fertility restoration by seminal tract washout in ejaculatory obstruction. J Urol 153:1948–1950CrossRefPubMed

Title: Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment
Authors: Harry Fisch
Sarah M. Lambert
Erik T. Goluboff
Publication date: 01-12-2006
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 6/2006
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-006-0129-4

At a glance: The STEP trials

Springer Medicine

Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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