Ejaculatory Duct Obstruction(EDO)

Kim, Hyeong Gon; Paick, Jae Seung

Abstract

The diagnosis of ejaculatory duct obstruction(EDO) may be suspected on clinical grounds from the characteristic seminal analysis and is being confirmed by vasoseminal vesiculography. Through the analysis of our experienced cases, we defined the new characteristics of EDO in semen analysis and we investigated the role of TRUS in diagnosing this entity. We analyzed 23 EDO patients we experienced during the last 5 years. All cases were diagnosed by vasoseminal vesiculography. In last 16 patients, transrectal ultrasonography(TRUS) was performed before vasoseminal vesiculography and 15 patients(94% ) were suspected to be EDO. The cause of EDO were identified as midline cyst in 7 patients, Wolffian malformation in 4, previous genitourinary infection in 5, and unknown causes in 7. We have treated 21 patients. Fourteen patients were treated by transurethral resection (TUR), 5 patients by forceful lavage through vasotomy site, 2 patients by transseptal vasovasostomy. Eight (57%) of 14 patients treated by TUR achieved an improvement in semen volume and/or semen quality and 3 patients( 10% ) produced pregnancy. Six(86%) of 7 patients caused by midline cyst achieved improvement in semen parameters and 3 patients(43% ) produced pregnancy. Overall, ten of 21(48%) patients achieved improvement in semen characteristics, 3 patients(12%) produced pregnancy. Among our cases, six patients presented with a subtle and mild abnormalities in seminal fluid Their sperm density was above 10xl0'/ml while ejaculated volume was low to normal. Their sperm motility was consistently diminished(less than 35%) and semen fructose was low(less than 140). TRUS enabled to detect midline cyst or seminal vesicle dilatation in these partial EDO cases before vasoseminal vesiculography. Based on our experience of EDO we suggest that TRUS is the initial diagnostic procedure if infertile patients were suspected as EDO according to semen parameters. We suggest that if semen fructose was low in the athenospermic patient who has high sperm density( >0.000001/ml), TRUS should be performed.