An update on the diagnosis and management of ejaculatory duct obstruction

Abstract

Ejaculatory duct obstruction (EDO) remains a rare but surgically correctable cause of male sexual dysfunction and male infertility due to obstructive azoospermia, diagnosed in up to 5% of infertile men. EDO should, therefore, be considered within the list of differential diagnoses for men undergoing infertility investigations, with work up including clinical examination, transurethral ultrasonography, semen analysis, chromotubation, seminal vesiculography and seminal vesicle aspiration. Obstruction can be limited to the distal ends of the ducts or it can extend proximally to include the terminal portions of the vasa deferentia, with the site and length of the obstruction having implications for surgical intervention. Early endoscopic treatment can reverse symptoms and prevent the progression of partial obstruction to bilateral, complete obstruction, and transurethral resection of the ejaculatory duct remains the main treatment option for EDO. Alternative treatment options include endoscopic laser-assisted resection of the ducts, antegrade seminal-vesicle lavage to relieve EDO secondary to inspissated material or calculi, or dilatation of the ejaculatory ducts using 9F seminal vesicoscopy or balloon.

Anatomical study of the seminal vesicle system for transurethral seminal vesiculoscopy

“…Furthermore, Yang et al () observed that in most cases, obstruction was present at the level of the seminal colliculus. Modgil et al () reported that obstruction was limited to the distal ends of the ejaculatory ducts. The region within the seminal vesicle system prone to calcification or obstruction corresponds to the second or third segment described in our study.…”

In VitroandIn VivoAssessment of FK506 Analogs as Novel Antifungal Drug Candidates

“…Notably, the calcineurin pathway also plays pivotal roles in plant and animal fungal pathogens (25,26). In C. neoformans, which causes fatal systemic cryptococcosis and meningoencephalitis (27), the calcineurin pathway is required for maintenance of cell wall integrity and survival at mammalian body temperature (28). In C. albicans, which causes both superficial and systemic candidiasis (29), calcineurin is required for survival in the presence of serum (30)(31)(32)(33).…”

Transurethral Resection of Ejaculatory Duct in Primary Infertile Men with Distal Ejaculatory Duct Obstruction

“…Although vasography is accepted as the gold standard for diagnosis, transrectal ultrasound (TRUS) has become the essential imaging modality because of its less invasive nature (6). The standard treatment procedure for distal EDO is transurethral resection of the ejaculatory ducts (TURED) (7).…”