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Original ArticleOpen Access
Ejaculatory Duct Obstruction in the Infertile Male : Experience of 7 Cases at Ramathibodi
Kochakam W 
,
RatanaOlam K ,
Leenanupunth C ,
Viseshsindh V ,
Muangman V
,
RatanaOlam K ,
Leenanupunth C ,
Viseshsindh V ,
Muangman V KRISADA RATANA-OLARN, M.D.*,
VIRA VISESHSINDH, M.D.*,
Objective
: To study the clinical presentations, management, outcomes as well as preg-
nancy rate of ejaculatory duct obstruction treated at the Division of Urology, Ramathibodi Hospital.
Material and Method
: This retrospective study was done from 1980 to 1999 and infor-
mation from the medical records of the patients of ejaculatory duct obstruction was obtained. Phone
and mail were used for long-term follow-up.
Results
: Seven male patients with ejaculatory duct obstruction were identified. The age
ranged from 32-45 years old (mean 34.5). All of the patients had azoospermia without other
symptoms related to ejaculatory duct obstruction such as painful ejaculation, perineal or testicular
pain. Normal testicles and secondary sex characteristics were noted in all. Seventy-one per
cent had normal hormonal profiles and twenty-nine per cent had a slight increase of FSH, LH
but not more than one fold of normal range. Vasography was used as the diagnosis tool in all of
the cases and 71 per cent of seminal vesicles were >1.5 em in diameter and all the rest were
1
em in diameter. Transurethral resection of ejaculatory duct (TURED) was done in 6 cases and
transurethral incision of ejaculatory duct (TUIED) was done in 1 case. Semen analysis was done
in the third month after operation and 4 of 7 (57%) showed improvement of semen analysis but
another 3 cases (43%) still had azoospermia. Six months after operation 6 of 7 (86%) showed
improvement of semen analysis. Up to one year, 6 of 7 (86%) have normal semen analysis and
another one still had azoospermia. In the long-term follow-up, 4 of 7 (57%) were able to impreg-
nate their wives.
Conclusions
: Ejaculatory duct obstruction is a treatable cause of male infertility. In an
infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex
characteristics, testes and normal hormonal profiles, ejaculatory duct obstruction is suggested.
Transrectal ultrasonography (TRUS) and/or vasography can be done to confirm the dilatation
Vo1.84 No.8
EJACULATORY DUCT OBSTRUCTION IN THE INFERTILE MALE
1149
of seminal vesicles and obstruction of the ejaculatory duct. Transurethral resection of the ejacula-
tory duct (TURED) has resulted in marked improvement in semen parameters, and pregnancies have
been achieved.
Key word : Infertility, Male, Ejaculatory Duct, Azoospermia
VIRA VISESHSINDH, M.D.*,
Objective
: To study the clinical presentations, management, outcomes as well as preg-
nancy rate of ejaculatory duct obstruction treated at the Division of Urology, Ramathibodi Hospital.
Material and Method
: This retrospective study was done from 1980 to 1999 and infor-
mation from the medical records of the patients of ejaculatory duct obstruction was obtained. Phone
and mail were used for long-term follow-up.
Results
: Seven male patients with ejaculatory duct obstruction were identified. The age
ranged from 32-45 years old (mean 34.5). All of the patients had azoospermia without other
symptoms related to ejaculatory duct obstruction such as painful ejaculation, perineal or testicular
pain. Normal testicles and secondary sex characteristics were noted in all. Seventy-one per
cent had normal hormonal profiles and twenty-nine per cent had a slight increase of FSH, LH
but not more than one fold of normal range. Vasography was used as the diagnosis tool in all of
the cases and 71 per cent of seminal vesicles were >1.5 em in diameter and all the rest were
1
em in diameter. Transurethral resection of ejaculatory duct (TURED) was done in 6 cases and
transurethral incision of ejaculatory duct (TUIED) was done in 1 case. Semen analysis was done
in the third month after operation and 4 of 7 (57%) showed improvement of semen analysis but
another 3 cases (43%) still had azoospermia. Six months after operation 6 of 7 (86%) showed
improvement of semen analysis. Up to one year, 6 of 7 (86%) have normal semen analysis and
another one still had azoospermia. In the long-term follow-up, 4 of 7 (57%) were able to impreg-
nate their wives.
Conclusions
: Ejaculatory duct obstruction is a treatable cause of male infertility. In an
infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex
characteristics, testes and normal hormonal profiles, ejaculatory duct obstruction is suggested.
Transrectal ultrasonography (TRUS) and/or vasography can be done to confirm the dilatation
Vo1.84 No.8
EJACULATORY DUCT OBSTRUCTION IN THE INFERTILE MALE
1149
of seminal vesicles and obstruction of the ejaculatory duct. Transurethral resection of the ejacula-
tory duct (TURED) has resulted in marked improvement in semen parameters, and pregnancies have
been achieved.
Key word : Infertility, Male, Ejaculatory Duct, Azoospermia
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