Urethro-Ejaculatory Duct Reflux, a Complication of Peno-Bulbar Urethral Stricture: Case Report with Review of the Literature

Abstract

Urethro-ejaculatory duct reflux (UEDR) is an uncommonly discussed entity that may result in devastating complications. We discuss the case of a young married male with obstructive voiding symptoms along with intermittent left scrotal pain for last the 2 years. On voiding cystourethrography, he had intravasation of contrast into the prostatic ducts, vas deferens and epididymal ducts suggestive of UEDR which might be the cause of his scrotal pain due to recurrent episodes of epididymitis. Complete resolution of voiding symptoms and recurrent scrotal pain occurred after management of urethral stricture. The possibility of UEDR should be kept in mind while dealing with men suffering from recurrent prostatitis, seminal vesiculitis, epididymitis or, less commonly, infertility.

Dietary habits and lifestyle related to the effectiveness of l ow‐intensity extracorporeal shock wave therapy for chronic prostatitis/chronic pelvic pain syndrome‐like symptoms: Initial results

“…Studies have found that urine reflux into the prostatic duct induces abacterial prostatitis, and the possible mechanism underlying this phenomenon may be related to increasing pressure in the bladder and prostatic hypoxia (Funahashi et al, 2017; Garg et al, 2014). Thus, holding back urine and not urinating after sex might be related to CP/CPPS.…”

Ejaculatory duct reflux revealed by chronic scrotal swelling in an adult

“… 1 The second mechanism is an obstacle to the flow of urine beyond the ejaculatory ducts, which has been described in both children (posterior urethral valve) and adults (urethral stricture). 2 In these situations, the reflux is usually bilateral. In our case, a double mechanism can explain the reflux: The unilateral characteristic and the history of hypospadias surgery are in favor of an anatomical abnormality, associated with a narrowing of the urethra.…”

“…It may be asymptomatic, or revealed by unexplained pelvic or scrotal pain, or recurrent genital infections (prostatitis, epididymitis, and orchitis). 1 , 2 The consequences of EBU can be severe, resulting in infertility due to epididymal and testicular fibrosis secondary to infections and chronic inflammation. 3 Our patient presented with a dilated epididymis, destroyed by the EBU with an atrophic testis.…”

“…The diagnosis of EDR is confirmed radiologically, by opacification of the lower urinary tract, during retrograde urethrography, or at best by micturating cystourethrography. 2 , 4 The reflux may be uni or bilateral and may involve the vas deferens, the seminal vesicle or the entire genital tract. In a retrospective study of EDR in the pediatric population including 54 cases, Wiersma found that reflux was limited to the seminal vesicle in 74% and that larger refluxes were associated with severe epididymal and testicular damage, such as the case described in this observation.…”

“…A vasectomy can be proposed in EDR with recurrent orchiepididymitis to prevent pain and preserve the testicular parenchyma. 2 The injection of a bulking agent into the verumontanum to prevent EDR has also been proposed by some authors. 5 However, given the rarity of this condition, no treatment is currently recommended, except for the need to correct an underlying obstruction.…”