Skip to main content

Advertisement

SpringerLink
Log in

Transurethral resection of ejaculatory duct in infertile men: outcome and predictors of success

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the outcome of transurethral resection of the ejaculatory duct (TURED) in the treatment for ejaculatory duct obstruction (EDO) and define predictors of success.

Materials and methods

We retrospectively evaluated 23 infertile men between 2006 and 20011, who were diagnosed as having EDO. Inclusion criteria were azoospermia or oligozoospermia, low ejaculate volume, low ejaculate PH, little or no fructose in seminal plasma with normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonography (TRUS) or magnetic resonance images (MRI). Seventeen patients were diagnosed as complete EDO, and the remaining 6 were considered as having partial EDO. All patients were treated by TURED.

Results

Midline cysts were diagnosed in seven cases, and the remaining 16 patients had postinflammatory obstruction of ejaculatory ducts (ED). Overall, a significant improvement of semen quality was achieved after surgery. All patients with partial EDO showed improvements in semen parameters after TURED compared to 23.5 % (4/17) in those with complete EDO. Improvement in sperm count was 71.5 % and 31 % for patients with midline cysts and patients with non-cystic causes of EDO, respectively. Six (26 %) patients developed complications including epididymo-orchitis in 2, watery ejaculate in 3 and conversion to azoospermia in 1. Spontaneous pregnancies were achieved in 3 (13 %) cases: 2 (33.3 %) men with partial and 1 (5.9 %) with complete obstruction.

Conclusion

Partial EDO, whatever the etiology, has an excellent outcome after TURED. Complete EDO due to cysts appears to respond better than postinflammatory obstruction to TURED.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Porch PP Jr (1978) Aspermia owing to obstruction of distal ejaculatory duct and treatment by transurethral resection. J Urol 119(1):141–142

    PubMed  Google Scholar 

  2. Turek PJ (2006) Seminal vesicle and ejaculatory duct surgery. In: Graham S (ed) Glenn’s urologic surgery, 2004. 6th edition. Philadelphia, Lippincott, Williams & Wilkins, pp 439–45

  3. Smith JF, Walsh TJ, Turek PJ (2008) Ejaculatory duct obstruction. Urol Clin N Am 35:221–227

    Article  Google Scholar 

  4. Schroeder-Printzen I, Ludwig M, Köhn F, Weidner W (2000) Surgical therapy in infertile men with ejaculatory duct obstruction: technique and outcome of a standardized surgical approach. Hum Reprod 15(6):1364–1368

    Article  PubMed  CAS  Google Scholar 

  5. Engin G, Kadioğlu A, Orhan I, Akdöl S, Rozanes I (2000) Transrectal US and endorectal MR imaging in partial and complete obstruction of the seminal duct system.A comparative study. Acta Radiol 41(3):288–295

    Article  PubMed  CAS  Google Scholar 

  6. Meacham RB, Hellerstein DK, Lipshultz LI (1993) Evaluation and treatment of ejaculatory duct obstruction in the infertile male. Fertil Steril 59(2):393–397

    PubMed  CAS  Google Scholar 

  7. Nagler HM, Rotman M, Zoltan E, Fisch H (2002) The natural history of partial ejaculatory duct obstruction. J Urol 167(1):253–254

    Article  PubMed  Google Scholar 

  8. Pryor JP, Hendry WF (1991) Ejaculatory duct obstruction in subfertile males: analysis of 87 patients. Fertil Steril 56(4):725–730

    PubMed  CAS  Google Scholar 

  9. 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(1):138–142

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. Goluboff ET, Stifelman MD, Fisch H (1995) Ejaculatory duct obstruction in the infertile male. Urology 45:925–931

    Article  PubMed  CAS  Google Scholar 

  12. Yurdakul T, Gokce G, Kilic O, Piskin MM (2008) Transurethral resection of ejaculatory ducts in the treatment of complete ejaculatory duct obstruction. Int Urol Nephrol 40(2):369–372

    Article  PubMed  Google Scholar 

  13. Fuse H, Mizuno I, Iwasaki M, Akashi T (2003) Transurethral treatment of ejaculatory duct obstruction in infertile men. Arch Androl 49(6):429–431

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  16. Purohit RS, Wu DS, Shinohara K, Turek PJ (2004) A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol 171(1):232–235

    Article  PubMed  Google Scholar 

  17. Jarow JP (1994) Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction. J Urol 152(3):899–901

    PubMed  CAS  Google Scholar 

  18. Jarow JP (1996) Seminal vesicle aspiration of fertile men. J Urol 156(3):1005–1007

    Article  PubMed  CAS  Google Scholar 

  19. Engin G, Celtik M, Sanli O, Aytac O, Muradov Z, Kadioglu A (2009) Comparison of transrectal ultrasonography and transrectal ultrasonography-guided seminal vesicle aspiration in the diagnosis of the ejaculatory duct obstruction. Fertil Steril 92(3):964–970

    Article  PubMed  Google Scholar 

  20. Riedenklau E, Buch JP, Jarow JP (1995) Diagnosis of vasal obstruction with seminal vesiculography: an alternative to vasography in select patients. Fertil Steril 64(6):1224–1227

    PubMed  CAS  Google Scholar 

  21. Xu B, Niu X, Wang Z, Li P, Qin C, Li J, Liu B, Wang P, Jia Y, Wu H, Zhang W (2011) Novel methods for the diagnosis and treatment of ejaculatory duct obstruction. BJU Int 108(2):263–266

    Article  PubMed  Google Scholar 

  22. Kayser O, Osmonov D, Harde J, Girolami G, Wedel T, Schäfer P (2012) Less invasive causal treatment of ejaculatory duct obstruction by balloon dilation: a case report, literature review and suggestion of a CT- or MRI-guided intervention. Ger Med Sci 10:06

    Google Scholar 

  23. Colpi GM, Negri L, Patrizio P, Pardi G (1995) Fertility restoration by seminal tract washout in ejaculatory duct obstruction. J Urol 153(6):1948–1950

    Article  PubMed  CAS  Google Scholar 

  24. Halpern EJ, Hirsch IH (2000) Sonographically guided transurethral laser incision of a Müllerian duct cyst for treatment of ejaculatory duct obstruction. AJR Am J Roentgenol 175(3):777–778

    PubMed  CAS  Google Scholar 

  25. Vazquez-Levin MH, Dressler KP, Nagler HM (1994) Urine contamination of seminal fluid after transurethral resection of the ejaculatory ducts. J Urol 152(6 Pt 1):2049–2052

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Ahmed El-Assmy & Hosam El-Tholoth

  2. Departments of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Rasha T. Abouelkheir & Mohamed E. Abou-El-Ghar

Authors
  1. Ahmed El-Assmy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hosam El-Tholoth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rasha T. Abouelkheir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed E. Abou-El-Ghar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed El-Assmy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Assmy, A., El-Tholoth, H., Abouelkheir, R.T. et al. Transurethral resection of ejaculatory duct in infertile men: outcome and predictors of success. Int Urol Nephrol 44, 1623–1630 (2012). https://doi.org/10.1007/s11255-012-0253-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-012-0253-6

Keywords

Search

Navigation