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Ejaculatory Duct Obstruction and TURED
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Ejaculatory Duct Obstruction (EDO) and
Transurethral Resection of the Ejaculatory Duct (TURED)
Transurethral Resection of the Ejaculatory Duct (TURED)
Ejaculatory duct obstruction might be suspected during the male infertility evaluation.
The ejaculatory duct is the ultimate part of the reproductive tract that delivers sperm
into the penis, prior to ejaculation. It represents the confluence of two structures, the
vas deferens and seminal vesicles. It is very important because it is the interface
between the reproductive and urinary systems.
The ejaculatory duct can be affected by a few conditions that can hinder a man's
fertility. A man may be born with an obstruction caused by a congenital cyst called a
Mullerian Duct Cyst. He can also become obstructed or become blocked by
calcifications or scarring due to infections such as sexually transmitted diseases
(gonorrhea, chlamydia, etc) or prostatitis. Ejaculatory duct cysts, calcification or
scarring can partially or completely block the ejaculatory duct.
Your physician might suspect an ejaculatory duct obstruction after reviewing the
semen analysis or based on a suspicious finding during digital rectal examination
(DRE). Low ejaculate volume (<1.5 ml), low sperm motility (<50% motile sperm) or
a midline cystic structure can all suggest either partial or complete obstruction of the
ejaculatory duct.
A transrectal ultrasound (TRUS) will be performed in order to confirm the presence
or absence of ejaculatory duct obstruction. Your physician will first survey for the
presence of a cyst or calcification at the ejaculatory duct. Then, the size of the
seminal vesicles will be measured to determine whether there is any significant
obstruction.
Your physician might also perform a seminal vesicle aspiration (SVA) at the same
time as your TRUS. This is another confirmatory test to diagnose ejaculatory duct
obstruction. The presence of sperm in the aspirate confirms the suspected
diagnosis. In the event you do require SVA, your physician will instruct you to take
antibiotics for three (3) days around the time of the procedure and perform an
enema several hours prior to the procedure.
Ejaculatory duct obstruction is effectively treated by transurethral resection of the
ejaculatory duct (TURED). This is a procedure done in the operating room under
general or regional anesthesia. The procedure is done entirely using endoscopic
instruments inserted through the penis. First, the seminal vesicle is injected with
blue dye (chromotubation). Then, the ejaculatory duct is resected, removing the
obstructive lesion. Blue dye will be seen effluxing from the ejaculatory duct if the
lesion is sucessfully resected. This is an outpatient procedure and the patient goes
home after recovering from anesthesia. A urethral catheter is left in place for 1 day
after the procedure. Your physician will determine when to perform your first semen
analysis.
The ejaculatory duct is the ultimate part of the reproductive tract that delivers sperm
into the penis, prior to ejaculation. It represents the confluence of two structures, the
vas deferens and seminal vesicles. It is very important because it is the interface
between the reproductive and urinary systems.
The ejaculatory duct can be affected by a few conditions that can hinder a man's
fertility. A man may be born with an obstruction caused by a congenital cyst called a
Mullerian Duct Cyst. He can also become obstructed or become blocked by
calcifications or scarring due to infections such as sexually transmitted diseases
(gonorrhea, chlamydia, etc) or prostatitis. Ejaculatory duct cysts, calcification or
scarring can partially or completely block the ejaculatory duct.
Your physician might suspect an ejaculatory duct obstruction after reviewing the
semen analysis or based on a suspicious finding during digital rectal examination
(DRE). Low ejaculate volume (<1.5 ml), low sperm motility (<50% motile sperm) or
a midline cystic structure can all suggest either partial or complete obstruction of the
ejaculatory duct.
A transrectal ultrasound (TRUS) will be performed in order to confirm the presence
or absence of ejaculatory duct obstruction. Your physician will first survey for the
presence of a cyst or calcification at the ejaculatory duct. Then, the size of the
seminal vesicles will be measured to determine whether there is any significant
obstruction.
Your physician might also perform a seminal vesicle aspiration (SVA) at the same
time as your TRUS. This is another confirmatory test to diagnose ejaculatory duct
obstruction. The presence of sperm in the aspirate confirms the suspected
diagnosis. In the event you do require SVA, your physician will instruct you to take
antibiotics for three (3) days around the time of the procedure and perform an
enema several hours prior to the procedure.
Ejaculatory duct obstruction is effectively treated by transurethral resection of the
ejaculatory duct (TURED). This is a procedure done in the operating room under
general or regional anesthesia. The procedure is done entirely using endoscopic
instruments inserted through the penis. First, the seminal vesicle is injected with
blue dye (chromotubation). Then, the ejaculatory duct is resected, removing the
obstructive lesion. Blue dye will be seen effluxing from the ejaculatory duct if the
lesion is sucessfully resected. This is an outpatient procedure and the patient goes
home after recovering from anesthesia. A urethral catheter is left in place for 1 day
after the procedure. Your physician will determine when to perform your first semen
analysis.
A cyst is identified on TRUS
obstructing the ejaculatory duct
obstructing the ejaculatory duct
Seminal vesicle aspiartion
identifies sperm
identifies sperm
Endoscopic view of ejaculatory duct
immediately prior to resection
immediately prior to resection
After resection of the cyst, blue dye
is seen freely effluxing from the now
un-obstructed ejacualtory duct
is seen freely effluxing from the now
un-obstructed ejacualtory duct
