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Ejaculatory duct obstruction in the infertile male: experience of 7 cases at Ramathibodi Hospital.
J Med Assoc Thai. 2001 Aug; 84(8):1148-52.JM

Abstract

OBJECTIVE

To study the clinical presentations, management, outcomes as well as pregnancy rate of ejaculatory duct obstruction treated at the Division of Urology, Ramathibodi Hospital.

MATERIAL AND METHOD

This retrospective study was done from 1980 to 1999 and information from the medical records of the patients of ejaculatory duct obstruction was obtained. Phone and mail were used for long-term follow-up.

RESULTS

Seven male patients with ejaculatory duct obstruction were identified. The age ranged from 32-45 years old (mean 34.5). All of the patients had azoospermia without other symptoms related to ejaculatory duct obstruction such as painful ejaculation, perineal or testicular pain. Normal testicles and secondary sex characteristics were noted in all. Seventy-one per cent had normal hormonal profiles and twenty-nine per cent had a slight increase of FSH, LH but not more than one fold of normal range. Vasography was used as the diagnosis tool in all of the cases and 71 per cent of seminal vesicles were >1.5 cm in diameter and all the rest were 1 cm in diameter. Transurethral resection of ejaculatory duct (TURED) was done in 6 cases and transurethral incision of ejaculatory duct (TUIED) was done in 1 case. Semen analysis was done in the third month after operation and 4 of 7 (57%) showed improvement of semen analysis but another 3 cases (43%) still had azoospermia. Six months after operation 6 of 7 (86%) showed improvement of semen analysis. Up to one year, 6 of 7 (86%) have normal semen analysis and another one still had azoospermia. In the long-term follow-up, 4 of 7 (57%) were able to impregnate their wives.

CONCLUSIONS

Ejaculatory duct obstruction is a treatable cause of male infertility. In an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes and normal hormonal profiles, ejaculatory duct obstruction is suggested. Transrectal ultrasonography (TRUS) and/or vasography can be done to confirm the dilatation of seminal vesicles and obstruction of the ejaculatory duct. Transurethral resection of the ejaculatory duct (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved.

Authors+Show Affiliations

Kochakarn W
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
Leenanupunth C
No affiliation info available
Muangman V
No affiliation info available
Ratana-Olarn K
No affiliation info available
Viseshsindh V
No affiliation info available

MeSH

AdultConstriction, PathologicEjaculatory DuctsFemaleFollicle Stimulating HormoneHumansLuteinizing HormoneMaleMiddle AgedOligospermiaPregnancyPregnancy OutcomeRadiographyRetrospective StudiesSperm CountThailandTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11758851

Citation

Kochakarn, W, et al. "Ejaculatory Duct Obstruction in the Infertile Male: Experience of 7 Cases at Ramathibodi Hospital." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 84, no. 8, 2001, pp. 1148-52.
Kochakarn W, Leenanupunth C, Muangman V, et al. Ejaculatory duct obstruction in the infertile male: experience of 7 cases at Ramathibodi Hospital. J Med Assoc Thai. 2001;84(8):1148-52.
Kochakarn, W., Leenanupunth, C., Muangman, V., Ratana-Olarn, K., & Viseshsindh, V. (2001). Ejaculatory duct obstruction in the infertile male: experience of 7 cases at Ramathibodi Hospital. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 84(8), 1148-52.
Kochakarn W, et al. Ejaculatory Duct Obstruction in the Infertile Male: Experience of 7 Cases at Ramathibodi Hospital. J Med Assoc Thai. 2001;84(8):1148-52. PubMed PMID: 11758851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ejaculatory duct obstruction in the infertile male: experience of 7 cases at Ramathibodi Hospital. AU - Kochakarn,W, AU - Leenanupunth,C, AU - Muangman,V, AU - Ratana-Olarn,K, AU - Viseshsindh,V, PY - 2002/1/5/pubmed PY - 2002/1/15/medline PY - 2002/1/5/entrez SP - 1148 EP - 52 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 84 IS - 8 N2 - OBJECTIVE: To study the clinical presentations, management, outcomes as well as pregnancy rate of ejaculatory duct obstruction treated at the Division of Urology, Ramathibodi Hospital. MATERIAL AND METHOD: This retrospective study was done from 1980 to 1999 and information from the medical records of the patients of ejaculatory duct obstruction was obtained. Phone and mail were used for long-term follow-up. RESULTS: Seven male patients with ejaculatory duct obstruction were identified. The age ranged from 32-45 years old (mean 34.5). All of the patients had azoospermia without other symptoms related to ejaculatory duct obstruction such as painful ejaculation, perineal or testicular pain. Normal testicles and secondary sex characteristics were noted in all. Seventy-one per cent had normal hormonal profiles and twenty-nine per cent had a slight increase of FSH, LH but not more than one fold of normal range. Vasography was used as the diagnosis tool in all of the cases and 71 per cent of seminal vesicles were >1.5 cm in diameter and all the rest were 1 cm in diameter. Transurethral resection of ejaculatory duct (TURED) was done in 6 cases and transurethral incision of ejaculatory duct (TUIED) was done in 1 case. Semen analysis was done in the third month after operation and 4 of 7 (57%) showed improvement of semen analysis but another 3 cases (43%) still had azoospermia. Six months after operation 6 of 7 (86%) showed improvement of semen analysis. Up to one year, 6 of 7 (86%) have normal semen analysis and another one still had azoospermia. In the long-term follow-up, 4 of 7 (57%) were able to impregnate their wives. CONCLUSIONS: Ejaculatory duct obstruction is a treatable cause of male infertility. In an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes and normal hormonal profiles, ejaculatory duct obstruction is suggested. Transrectal ultrasonography (TRUS) and/or vasography can be done to confirm the dilatation of seminal vesicles and obstruction of the ejaculatory duct. Transurethral resection of the ejaculatory duct (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/11758851/Ejaculatory_duct_obstruction_in_the_infertile_male:_experience_of_7_cases_at_Ramathibodi_Hospital_ DB - PRIME DP - Unbound Medicine ER -