Evaluation and Treatment of Ejaculatory Duct Obstruction – UK single centre experience.
BAUS ePoster online library. Randhawa K. Jun 24, 2019; 259534; P4-5
Ms. Karen Randhawa
Ms. Karen Randhawa
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Abstract
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Ejaculatory duct obstruction (EDO) remains a rare but surgically correctable cause of haematospermia, ejaculatory disorders and male infertility occurring in 5% of men. EDO often presents with infertility, however patients may present with decreased force of ejaculate, periejaculatory pain, decreased ejaculate volume and haematospermia.

METHODS

Retrospective analysis of 62 patients diagnosed with EDO over 16 years. Patients were evaluated by history, examination, trans-rectal ultrasonography (TRUS) and semen analysis if indicated. Patients presenting with infertility had full hormonal and genetic profile performed. All patients had transurethral resection of ejaculatory ducts (TURED) or TUR cyst deroofing for midline cysts.

RESULTS

Mean patient age was 36 years.(Table 1)

The cause of EDO was congenital midline cyst in 38 patients, idiopathic in 12 and associated with calculi in 12. TURED was found to resolve haematospermia in 87% of patients presenting with this symptom alone.
Complication rate of 17.7% was seen including infection, retention and retrograde ejaculation.

Thirty-two presented with infertility; of these sixteen underwent TURED and sixteen TUR deroofing. Semen parameters are compared in Table 2. Treatment of prostatic cysts significantly improved concentration and motility in infertile patients (p=0.011).


CONCLUSION

In selected patients, TURED and TUR deroofing can result in marked improvements in semen parameters and symptoms. Although complication risk is high, effects are mild and transient. EDO is a common cause of obstructive azoospermia, haematospermia or ejaculatory pain. A simple semen volume may help the general urologist in diagnosing patients. Careful patient selection, adequate counselling and surgical experience are essential for optimal results.
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