Ejaculatory duct obstruction in subfertile males: analysis of 87 patients

• Published in: Fertility and sterility Vol. 56; no. 4; pp. 725 - 730
• Main Authors: Pryor, John P., Hendry, William F.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1991; Elsevier Science
• Subjects: Biological and medical sciences; Birth control; Constriction, Pathologic - etiology; Constriction, Pathologic - pathology; Cysts - complications; Ejaculatory Ducts - pathology; Ejaculatory Ducts - surgery; Female; Gynecology. Andrology. Obstetrics; Humans; Infection - complications; Infertility, Male - etiology; Infertility, Male - pathology; Infertility, Male - surgery; Male; Medical sciences; Mullerian Ducts; Postoperative Complications; Pregnancy; Prostatic Neoplasms - complications; Retrospective Studies; Sperm Count; Sterility. Assisted procreation; Wolffian Ducts - abnormalities; Wounds and Injuries - complications; Human; Semen pathway; Treatment; Etiology; Male sterility; Male genital diseases; Obstruction
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(16)54606-8

To study the causes, presentation, and treatment of ejaculatory duct obstruction in subfertile males. Collaborative retrospective study of clinical experience collected by two urologists over a 15-year period. National Health Service and Private Care Hospitals. Subfertile males with azoospermia (n=67), very severe oligozoospermia (n=17), oligozoospermia (n=1), or normal sperm concentration (n=2) in small volume ejaculates with acid pH and little or no fructose. Exploration of scrotum with vasogram and testicular biopsy, plus reconstruction if possible. Follow-up seminal analysis and occurrence of pregnancy in female partners. The causes were: müllerian duct cyst (n=17); wolffian duct malformation (n=19); previous surgical trauma (e.g., imperforate anus) (n=15); previous genital infection (n=19); tuberculosis (n=8); megavesicles (pathological dilatation of vesicles and ampullae of unknown cause) (n=8); and carcinoma of prostate (n=1). After incision of Mullerian duct cysts, five pregnancies were produced. Five pregnancies occurred in the other groups using a variety of surgical techniques. Routine vasography has shown that ejaculatory duct obstruction is not as rare as previously thought. The diagnosis should not be missed because the condition is simple to correct surgically in certain cases.