Login to Access Video or Poster Abstract: MP89-13
Sources of Funding: none

Introduction

Ejaculatory duct obstruction (EDO), is either complete or partial and it affects 5% of infertile men. Complete obstruction occurs in up to 1% of the infertile male population while incomplete obstruction occurs in up to 4.4% of the infertile male population. _x000D_ _x000D_ EDO often presents with infertility. In some patients EDO is symptomatic and patients may present with: decreased force of ejaculate, pain on or after ejaculation, decreased ejaculate volume, haemospermia, perineal or testicular pain, low back pain and dysuria._x000D_ _x000D_ We set out to determine the presentation and treatment outcome of EDO._x000D_

Methods

A retrospective analysis of 54 patients diagnosed with EDO over the past 7 years._x000D_ Patients were evaluated by history, examination, semen analysis and trans-rectal ultrasonography (TRUS). Patients presenting with infertility also had hormonal profile and male reproductive genetic profile._x000D_ _x000D_ All patients had transurethral resection of the ejaculatory ducts (TURED) or TUR cyst deroofing for midline cysts. _x000D_

Results

The mean (range) patient age was 38(24-64) years. Twenty three patients (42%) presented with ejaculatory disorders, 20 patients (37%) presented with infertility, and 11 with pelvic pain or urinary symptoms. 9 (16%) of these men presented with both infertility and ejaculatory disorders._x000D_ _x000D_ The cause of EDO was congenital midline cyst in 30 patients (56%), idiopathic in 6 (11%), mullerian duct syndrome in 2 (4%), associated with unilateral vasal aplasia in 5 (9%), and ejaculatory duct obstruction associated with calculi in 11 (20%)._x000D_ Of the 33 patients with symptomatic EDO; 22(68%) had complete cure while 5 (22%) had persistence of symptoms and 6 men did not attend for their follow up appointments._x000D_ _x000D_ Semen parameters pre and post procedure were available for 26 men. Improvements were seen in 16 of these men; Mean (range) sperm count was 12.5 (0-75) x106/cc pre-operatively and 25 x106/cc (4 to 137) post TURED. Average semen volume increased from 0.9 to 3.7 mls and mean motility increased from 10% (0-45%) to 43%(14-68%). 10 men remained azoospermic suggesting an associated proximal obstruction._x000D_ _x000D_ Complications occurred in 7 patients (18%): epididymitis (3), chronic pelvic pain (1), retrograde ejaculation (1) and urine retention (2). _x000D_

Conclusions

EDO is an underdiagnosed cause of ejaculatory disorders. Excluding EDO is important in the management of patients presenting with ejaculatory disorders in addition to infertile males. _x000D_ _x000D_ It can be easily diagnosed by TRUS. TURED is an effective and safe treatment for EDO.

Funding

none