Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology?

Objective: To describe the pathology-specific response to transurethral res ection of ejaculatory ducts (TURED) in patients with complete or partial ej aculatory duct obstruction and to evaluate the role of TURED in light of po werful 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 reson ance imaging, and treatment with TURED. Main Outcome Measure(s): Changes in semen variables, pregnancy outcomes, an d complication rates were analyzed before and after surgery. Result(s): Improvement in semen variables was significantly better in patie nts with partial obstruction (94%) of ducts than in those with complete obs truction (59%) CP=.04). Cystic obstruction, especially midline and eccentri c cysts, responded best to TURED. Before surgery, all patients were candida tes for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospe rmic men conceived spontaneously or were referred for IUI instead of IVF/IC SI. 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 pr imary treatment in many cases. Finally, TURED may allow IVF/ICSI to be perf ormed with ejaculated rather than surgically retrieved sperm. (C) 2001 by A merican Society for Reproductive Medicine.