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Transrectal ultrasound- and fluoroscopic-assisted transurethral incision of ejaculatory ducts: a problem-solving approach to nonmalignant hematospermia due to ejaculatory duct obstruction.
J Endourol. 2008 Jul; 22(7):1531-5.JE

Abstract

PURPOSE

Ejaculatory duct obstruction (EJDO) has traditionally been managed with transurethral resection of ejaculatory ducts (TURED). However, wide resection has potential complications and risk of postoperative morbidity. We demonstrate a technique using transrectal ultrasonography (TRUS) and fluoroscopy to assist with transurethral incision of the ejaculatory duct (TUIED) to treat hematospermia due to obstruction by either a stone or a prostatic cyst.

MATERIALS AND METHODS

Twenty-five patients with ejaculatory disorders including hematospermia underwent TUIED between 1997 and 2005. Diagnosis, the cause of hematospermia, and the level of EJDO was confirmed by semen analysis, semen culture, and TRUS. All patients were subjected to TRUS-guided seminal vesicle aspiration followed by seminal vesiculography using methylene blue mixed with contrast under biplanar TRUS guidance and fluoroscopic monitoring. After confirming the cause and level of obstruction, the ejaculatory duct was opened using endoscissors until the obstruction was relieved as confirmed by free flow of methylene blue. Stones were removed if any were present. A Foley catheter was kept in place for 24 hours.

RESULTS

Improvement of symptoms was noted in 96% of patients with ejaculatory disorders. All patients with painful ejaculation and hematospermia had complete remission of symptoms at 3 months postoperatively; three patients had transient epididymo-orchitis, and none had retrograde ejaculation or incontinence.

CONCLUSION

TUIED is a viable and minimally-invasive option for treating EJDO causing ejaculatory disorders including hematospermia with minimal morbidity and early recovery.

Authors+Show Affiliations

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18690817

Citation

Manohar, T, et al. "Transrectal Ultrasound- and Fluoroscopic-assisted Transurethral Incision of Ejaculatory Ducts: a Problem-solving Approach to Nonmalignant Hematospermia Due to Ejaculatory Duct Obstruction." Journal of Endourology, vol. 22, no. 7, 2008, pp. 1531-5.
Manohar T, Ganpule A, Desai M. Transrectal ultrasound- and fluoroscopic-assisted transurethral incision of ejaculatory ducts: a problem-solving approach to nonmalignant hematospermia due to ejaculatory duct obstruction. J Endourol. 2008;22(7):1531-5.
Manohar, T., Ganpule, A., & Desai, M. (2008). Transrectal ultrasound- and fluoroscopic-assisted transurethral incision of ejaculatory ducts: a problem-solving approach to nonmalignant hematospermia due to ejaculatory duct obstruction. Journal of Endourology, 22(7), 1531-5. https://doi.org/10.1089/end.2007.0415
Manohar T, Ganpule A, Desai M. Transrectal Ultrasound- and Fluoroscopic-assisted Transurethral Incision of Ejaculatory Ducts: a Problem-solving Approach to Nonmalignant Hematospermia Due to Ejaculatory Duct Obstruction. J Endourol. 2008;22(7):1531-5. PubMed PMID: 18690817.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transrectal ultrasound- and fluoroscopic-assisted transurethral incision of ejaculatory ducts: a problem-solving approach to nonmalignant hematospermia due to ejaculatory duct obstruction. AU - Manohar,T, AU - Ganpule,Arvind, AU - Desai,Mahesh, PY - 2008/8/12/pubmed PY - 2008/10/28/medline PY - 2008/8/12/entrez SP - 1531 EP - 5 JF - Journal of endourology JO - J Endourol VL - 22 IS - 7 N2 - PURPOSE: Ejaculatory duct obstruction (EJDO) has traditionally been managed with transurethral resection of ejaculatory ducts (TURED). However, wide resection has potential complications and risk of postoperative morbidity. We demonstrate a technique using transrectal ultrasonography (TRUS) and fluoroscopy to assist with transurethral incision of the ejaculatory duct (TUIED) to treat hematospermia due to obstruction by either a stone or a prostatic cyst. MATERIALS AND METHODS: Twenty-five patients with ejaculatory disorders including hematospermia underwent TUIED between 1997 and 2005. Diagnosis, the cause of hematospermia, and the level of EJDO was confirmed by semen analysis, semen culture, and TRUS. All patients were subjected to TRUS-guided seminal vesicle aspiration followed by seminal vesiculography using methylene blue mixed with contrast under biplanar TRUS guidance and fluoroscopic monitoring. After confirming the cause and level of obstruction, the ejaculatory duct was opened using endoscissors until the obstruction was relieved as confirmed by free flow of methylene blue. Stones were removed if any were present. A Foley catheter was kept in place for 24 hours. RESULTS: Improvement of symptoms was noted in 96% of patients with ejaculatory disorders. All patients with painful ejaculation and hematospermia had complete remission of symptoms at 3 months postoperatively; three patients had transient epididymo-orchitis, and none had retrograde ejaculation or incontinence. CONCLUSION: TUIED is a viable and minimally-invasive option for treating EJDO causing ejaculatory disorders including hematospermia with minimal morbidity and early recovery. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/18690817/Transrectal_ultrasound__and_fluoroscopic_assisted_transurethral_incision_of_ejaculatory_ducts:_a_problem_solving_approach_to_nonmalignant_hematospermia_due_to_ejaculatory_duct_obstruction_ L2 - https://www.liebertpub.com/doi/10.1089/end.2007.0415?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -