V9-10: Transurethral resection of ejaculatory ducts: a step-by-step guide

V9-10: Transurethral resection of ejaculatory ducts: a step-by-step guide



Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. Transurethral resection of the ejaculatory ducts (TURED) serves as an important therapeutic management option for partially and/or completely obstructed ejaculatory ducts (EDs) that may result in significant improvement of semen parameters and pregnancy rate. The aim of this study is to demonstrate the key components for completing a successful TURED. _x000D_


We present a case of a 40-year-old man who presented with primary infertility. His past medical history was otherwise not significant. Physical examination revealed non-tender 14cc testes bilaterally with present and non-tender vas deferens and epididymis. Hormone studies were within the normal range. Semen analysis was abnormal (pH 6.4, volume of 0.7cc, concentration 16 million/cc and 7% motility). A trasnrectal ultrasonography revealed dilated seminal vesicles measuring more than 1.5 cm and seminal vesicle aspiration detected no sperm in the aspirate. _x000D_ We began the procedure by placing the patient in the conventional lithotomy position. Transrectal ultrasonography-guided seminal vesicle puncture was performed and methylene blue was injected into both seminal vesicles. Cystoscopy was performed focusing in the area of the verumontanum to assess for methylene blue drainage in order to more precisely proceed with resection of the ejaculatory ducts._x000D_ Vesiculography was performed by placing a 5 French ureteral into the freshly opened EDs in order to assess for patency and confirm both sides had been opened. Hemostasis was performed carefully in order not to occlude the newly open EDs. _x000D_


Patient was discharged home with foley catheter in place with a voiding trial performed one day later. He returned to clinic at 2 weeks for a post-operative evaluation. Semen analysis revealed improved parameters (pH 7.2, volume of 1cc, concentration 20 million/cc and 60% motility). _x000D_


The key portions for performing a successful TURED includes seminal vesicle instillation of methylene blue for easier ED identification. Vesiculography is performed near the end of the procedure to ensure both EDs have been opened as well as to assess for passive drainage of the seminal vesicles through the newly open EDs._x000D_

Funding: None