Diagnosis and treatment of ejaculatory duct obstruction in male infertility

Objective: To discuss the diagnosis and treatment of ejaculatory duct obstr uction in male infertility. Patients and Methods: Twenty-four males were treated for ejaculatory duct o bstruction between 1994 and 1998 in our clinic. Patients' age varied betwee n 20 and 40 (mean=29). Ejaculatory duct obstruction was considered in patie nts with low to normal ejaculate volume, azoospermia or oligospermia, decre ased motility, normal serum gonadotropin and testosterone levels, absent or low fructose in the ejaculate and evidence of obstruction on transrectal u ltrasonography. The definitive diagnosis was made by the absence of efflux of methylene blue injected through the vas during cytoscopy. All the patien ts were subjected to transurethral resection of ejaculatory ducts and sperm ograms before and 3 months after resection were compared. Results: Before transurethral resection mean sperm count was 1.66x10(6)/ml compared to 25.4x10(6)/ml postoperatively. The difference was statistically significant (p=0.001). After the operation, 58.3% of the cases had improve ment in sperm motility, and 62.5% had increased ejaculate volume. No signif icant complications occurred, and in only 1 (4.17%) patient, there was pers istent hematuria. After a mean follow-up period of 9 (6-18) months, 6 (25%) pregnancies were noted. Conclusion: Although transurethral resection is an effective method for the treatment of ejaculatory duct obstruction, the pregnancy rate is low which could be related to the hazardous effects of urinary reflux into ejaculato ry ducts or functional abnormalities of seminal vesicles. Copyright (C) 200 1 S. Karger AG, Basel.