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Transurethral resection of the ejaculatory ducts: etiology of obstruction and surgical treatment options.
Fertil Steril. 2019 03; 111(3):427-443.FS

Abstract

Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.

Authors+Show Affiliations

Division of Urology, Alpert Medical School of Brown University, Providence, Rhode Island.Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine Houston, Texas.Division of Urology, Alpert Medical School of Brown University, Providence, Rhode Island.Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: hwangky@upmc.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30827517

Citation

Avellino, Gabriella J., et al. "Transurethral Resection of the Ejaculatory Ducts: Etiology of Obstruction and Surgical Treatment Options." Fertility and Sterility, vol. 111, no. 3, 2019, pp. 427-443.
Avellino GJ, Lipshultz LI, Sigman M, et al. Transurethral resection of the ejaculatory ducts: etiology of obstruction and surgical treatment options. Fertil Steril. 2019;111(3):427-443.
Avellino, G. J., Lipshultz, L. I., Sigman, M., & Hwang, K. (2019). Transurethral resection of the ejaculatory ducts: etiology of obstruction and surgical treatment options. Fertility and Sterility, 111(3), 427-443. https://doi.org/10.1016/j.fertnstert.2019.01.001
Avellino GJ, et al. Transurethral Resection of the Ejaculatory Ducts: Etiology of Obstruction and Surgical Treatment Options. Fertil Steril. 2019;111(3):427-443. PubMed PMID: 30827517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transurethral resection of the ejaculatory ducts: etiology of obstruction and surgical treatment options. AU - Avellino,Gabriella J, AU - Lipshultz,Larry I, AU - Sigman,Mark, AU - Hwang,Kathleen, PY - 2018/12/20/received PY - 2019/01/02/accepted PY - 2019/3/5/entrez PY - 2019/3/5/pubmed PY - 2019/7/16/medline KW - Male infertility KW - ejaculatory duct obstruction KW - transurethral resection of ejaculatory duct SP - 427 EP - 443 JF - Fertility and sterility JO - Fertil Steril VL - 111 IS - 3 N2 - Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/30827517/Transurethral_resection_of_the_ejaculatory_ducts:_etiology_of_obstruction_and_surgical_treatment_options_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(19)30005-6 DB - PRIME DP - Unbound Medicine ER -