I-2: Ejaculatory Duct Obstruction

Ejaculatory duct obstruction (EDO) underlies 1-5% of male infertility, although the diagnosis of EDO can be complex, treatment is well established and can be very effective. Part of reason that this condition probably is underdiagnosed, is because of its rarity, subtle presentation and the concomitantly low index of suspicion held by physicians. The causes of EDO are divided into congenital and acquired disorders. Clinically, EDO classically presents as hematospermia, painful ejaculation, or infertility. In the past decade, transrectal ultrasound (TRUS) has replaced vasography as the main stay of diagnosis. Several adjunctive techniques now have been described for diagnosis of EDO, including seminal vesicle aspiration, seminal vesiculography, vesicle chromotubation. The time- tested treatment for EDO is resection of the ejaculatory ducts (TUR-ED), which is performed in an outpatient setting, and the technique combines cystourethroscopy with resection of the verumontanum in the midline. Complications from TUR-ED occur in 10-20% of the cases, and include watery ejaculate, hematuria, epididimitis, seminal vasculitis and low risk of incontinence or rectal perforation.