A Prospective Comparison of 3 Diagnostic Methods to Evaluate Ejaculatory Duct Obstruction

Purohit, Rajveer S.; Wu, David; Shinohara, Katsuto; Turek, Paul J.

doi:10.1097/01.ju.0000101909.70651.d1

Cited by 83 publications

(58 citation statements)

References 12 publications

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“…33 These is no consensus as to the value of these tests, and as such they are not recommended as routine investigations.…”

Section: Are There Symptoms Of Hypogonadism?mentioning

confidence: 99%

Steps in the investigation and management of low semen volume in the infertile man

Roberts¹,

Jarvi²

2013

CUAJ

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An adequate semen volume of ejaculate fluid is required to transport sperm into the female reproductive tract and allow for fertilization of the oocyte. Thus, seminal fluid volume is an important part of the semen analysis done to investigate male infertility. In this article, we review the anatomy and physiology of ejaculation, the various etiologies of low-volume ejaculation (artifactual, structural, functional). We then present a comprehensive algorithm for the evaluation, diagnosis and treatment of the infertile man presenting with low semen volume.

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“…33 These is no consensus as to the value of these tests, and as such they are not recommended as routine investigations.…”

Section: Are There Symptoms Of Hypogonadism?mentioning

confidence: 99%

Steps in the investigation and management of low semen volume in the infertile man

Roberts¹,

Jarvi²

2013

CUAJ

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“…Based on a suspicious semen analysis, transrectal ultrasound (TRUS) is performed to confirm the diagnosis. Recent literature suggests that: a) TRUS, as a static test, can overdiagnose EDO in up to 50% of cases as some "obstruction" may be functional and not physical, b) the addition of "dynamic" imaging prior to surgical treatment, such as ejaculatory duct chromotubation or vasography, can distinguish true obstruction from functional obstruction, and c) partial obstruction is more difficult to diagnose than complete obstruction as TRUS findings are less specific for partial obstruction (21). Overall, a 20-30% pregnancy rate can be expected from endoscopic treatment of EDO, and 70-80% of men will achieve a significant improvement in semen quality.…”

Section: Reproductive Tract Obstructionmentioning

confidence: 99%

Definition and current evaluation of subfertile men

Shefi

Turek

2006

Int. braz j urol.

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Male infertility affects 10% of reproductive aged couples worldwide and is treatable in many cases. In addition to other well-described etiologies, genetic causes of male infertility are now more commonly diagnosed. Using principles of evidencebased medicine, this review outlines diagnostic and treatments options to inform clinical management. In order of importance, randomized controlled clinical trials, basic scientific studies, meta-analyses, case-controlled cohort studies, best-practice policy recommendations and reviews from peer-reviewed literature were incorporated that provide organized and timely guidelines to the current management of male infertility. The strength of evidence for treatment recommendations is also classified when appropriate.

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“…The advent of TRUS has greatly facilitated the accurate diagnosis of distal seminal tract obstruction being less invasive. TRUS can provide information about the exact location of any cyst, or the level of obstructed ejaculatory duct, which is very helpful during TURED [32] .…”

Section: Stwmentioning

confidence: 99%

“…TRUS proved to be a reliable diagnostic tool in men with obstructive infertility, especially when combined with seminal analysis. TRUS is most commonly performed if the diagnosis of distal seminal tract obstruction is being considered [5,32] . The role TRUS is now firmly established in diagnosing post testicular causes of infertility.…”

Section: Scrotal Us Findings In Non Obstructive Azoospermiamentioning

confidence: 99%

“…The presence of more than three motile sperm per high-power field in the seminal vesicle aspirate obtained immediately after ejaculation indicates obstruction [39,45] . A the comparative analysis done by Purohit et al [32] , compared the four common diagnostic tests used to evaluate patients with distal seminal duct obstruction which are TRUS and three dynamic tests (chromotubation, seminal vesicle aspiration and seminal vesiculography). They concluded that TRUS alone has poor specificity for diagnosis of distal seminal duct obstruction as obstruction on TRUS was confirmed in only 52%, 48% and 36% of vesiculography, seminal vesicle aspiration and duct chromotubation studies, respectively.…”

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confidence: 99%

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Imaging in male-factor obstructive infertility

Donkol¹

2010

WJR

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The main purpose of imaging evaluation in male infertility is to identify and treat correctable causes of infertility, such as obstruction of the seminal tract. Various imaging modalities are available to evaluate men with obstructive infertility including scrotal ultrasonography, transrectal ultrasound (TRUS), vasography, magnetic resonance imaging, seminal vesicle aspiration, seminal tract washout, and seminal vesiculography. To date the most reliable and accurate diagnostic technique for obstructive infertility is unclear. In this review article, we report the role of these modalities in diagnosis of obstructive infertility. Scrotal sonography is the initial modality, and if patient results indicate non obstructive azoospermia as varicocele or testicular pathology they will be treated according to standard protocols for management of these pathologies. If the patient findings indicate proximal obstructive azoospermia, they can be managed by vasoepididymostomy. If the scrotal ultrasound is normal, TRUS is the second imaging modality. Accordingly, they are classified into patients with criteria of obstructive infertility without urogenital cysts where TRUS-guided aspiration and seminal vesiculography can be performed and transurethral resection of the ejaculatory ducts (TURED) will be the management of choice. In patients with urogenital cyst, TRUS-guided cyst aspiration and opacification are performed. If the cyst is communicating with the seminal tract, management will be transurethral incision of the cyst. If the cyst is not in communication, the obstruction may be relieved after cyst aspiration. If the obstruction is not relieved, TURED will be the management of choice. Sperm harvested during aspiration may be stored and used in assisted reproduction techniques. If the results of TRUS are inconclusive or doubtful, endorectal magnetic resonance imaging should be performed to serve as a "detailed map" for guiding corrective operative interventions.

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A Prospective Comparison of 3 Diagnostic Methods to Evaluate Ejaculatory Duct Obstruction

Cited by 83 publications

References 12 publications

Steps in the investigation and management of low semen volume in the infertile man

Steps in the investigation and management of low semen volume in the infertile man

Definition and current evaluation of subfertile men

Imaging in male-factor obstructive infertility

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