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Ejaculatory duct obstruction in infertile men.
BJU Int. 2000 Apr; 85(6):720-4.BI

Abstract

OBJECTIVE

To analyse our experience of ejaculatory duct obstruction (EDO) in infertile men, evaluating the diagnostic steps and the outcome of management according to the aetiology.

PATIENTS AND METHODS

Over a 7-year period, 50 infertile men were diagnosed with EDO as a contributory factor to male infertility. Diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, hormonal study, testicular biopsy, transrectal ultrasonography (TRUS) and/or vasography. Thirty-one patients with EDO were treated by transurethral resection (26) or forced lavage via a vasotomy (five).

RESULTS

In 45 of the 50 men, semen analyses showed the typical characteristics of complete EDO. Seminal values were variable in five cases of partial EDO; the semen fructose levels were < 1.4 g/L in all five. The main cause of EDO was a midline cyst in 16, Wolffian malformation in four, tuberculosis in 17, previous genitourinary infection in five and idiopathic in eight men. In 17 patients the seminal vesicles appeared to be atrophied on TRUS; 15 of these patients had a history of pulmonary tuberculosis and subsequent vasography in five showed multiple bilateral vasal obstruction. TRUS findings correlated well with vasography except in one case. The overall rate of improved semen values and paternity was 61% and 26%, respectively. Of 16 patients with midline cysts, 14 had improved semen variables and achieved paternity, seven after transurethral resection.

CONCLUSIONS

TRUS should be the first diagnostic procedure used when infertile men are suspected of having EDO, but vasography should still be considered for a more comprehensive diagnosis. In patients with atrophic seminal vesicles on TRUS and with a history of pulmonary tuberculosis, further study is unnecessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. The measurement of semen fructose may be helpful in diagnosing partial EDO. Patients with midline cysts who are treated by transurethral resection are expected to have the best outcome.

Authors+Show Affiliations

Department of Urology and Radiology, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10759673

Citation

Paick, J, et al. "Ejaculatory Duct Obstruction in Infertile Men." BJU International, vol. 85, no. 6, 2000, pp. 720-4.
Paick J, Kim SH, Kim SW. Ejaculatory duct obstruction in infertile men. BJU Int. 2000;85(6):720-4.
Paick, J., Kim, S. H., & Kim, S. W. (2000). Ejaculatory duct obstruction in infertile men. BJU International, 85(6), 720-4.
Paick J, Kim SH, Kim SW. Ejaculatory Duct Obstruction in Infertile Men. BJU Int. 2000;85(6):720-4. PubMed PMID: 10759673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ejaculatory duct obstruction in infertile men. AU - Paick,J, AU - Kim,S H, AU - Kim,S W, PY - 2000/4/12/pubmed PY - 2000/5/16/medline PY - 2000/4/12/entrez SP - 720 EP - 4 JF - BJU international JO - BJU Int VL - 85 IS - 6 N2 - OBJECTIVE: To analyse our experience of ejaculatory duct obstruction (EDO) in infertile men, evaluating the diagnostic steps and the outcome of management according to the aetiology. PATIENTS AND METHODS: Over a 7-year period, 50 infertile men were diagnosed with EDO as a contributory factor to male infertility. Diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, hormonal study, testicular biopsy, transrectal ultrasonography (TRUS) and/or vasography. Thirty-one patients with EDO were treated by transurethral resection (26) or forced lavage via a vasotomy (five). RESULTS: In 45 of the 50 men, semen analyses showed the typical characteristics of complete EDO. Seminal values were variable in five cases of partial EDO; the semen fructose levels were < 1.4 g/L in all five. The main cause of EDO was a midline cyst in 16, Wolffian malformation in four, tuberculosis in 17, previous genitourinary infection in five and idiopathic in eight men. In 17 patients the seminal vesicles appeared to be atrophied on TRUS; 15 of these patients had a history of pulmonary tuberculosis and subsequent vasography in five showed multiple bilateral vasal obstruction. TRUS findings correlated well with vasography except in one case. The overall rate of improved semen values and paternity was 61% and 26%, respectively. Of 16 patients with midline cysts, 14 had improved semen variables and achieved paternity, seven after transurethral resection. CONCLUSIONS: TRUS should be the first diagnostic procedure used when infertile men are suspected of having EDO, but vasography should still be considered for a more comprehensive diagnosis. In patients with atrophic seminal vesicles on TRUS and with a history of pulmonary tuberculosis, further study is unnecessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. The measurement of semen fructose may be helpful in diagnosing partial EDO. Patients with midline cysts who are treated by transurethral resection are expected to have the best outcome. SN - 1464-4096 UR - https://www.unboundmedicine.com/medline/citation/10759673/Ejaculatory_duct_obstruction_in_infertile_men_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1464-4096&amp;date=2000&amp;volume=85&amp;issue=6&amp;spage=720 DB - PRIME DP - Unbound Medicine ER -