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Ejaculatory Duct Obstruction(EDO)

Ejaculatory duct obstruction underlies 1-5% of male infertility. Although often a subtle and complex diagnosis, treatment is very effective. EDO is a more complex anatomical condition that takes several forms and can present in several ways.

Ejaculatory duct obstruction can present with

  • Infertility
  • Post-ejaculatory pain
  • Hematospermia.

Semen analysis showing low volume ejaculate with azoospermia defines complete or classic EDO and represent physical blockage of both ducts.

Unilateral complete or bilateral partial physical obstruction results in incomplete or partial EDO which is uniquely associated with oligoasthenospermia.

Diagnosis

  • Transrectal ultrasound is the first line diagnostic imaging test for EDO
  • Ejaculatory duct manometry
  • MRI Pelvis

Treatment

Indication for treatment of EDO includes:

  • Infertility
  • Recurrent Hematospermia
  • Dyspareunia (coital discomfort of post-ejacualatory pain)

There are various medications like Antihypertensive, Antipsychotic agents and antidepressants which can leads to impaired ejaculatory function and occasionally EDO.

Transurethral resection of the ejaculatory ducts (TURED)

This is the definitive treatment for EDO due to obstruction

This procedure is performed under anesthesia. Technique combines cystourethroscopy with resection of verumontanum in the midline or laterally. Patient can be discharged same day.

Formal semen analysis is done 2 weeks and at regular intervals thereafter, until semen quality stabilizes.

30%-40% natural pregnancy rate after TURED has been reported.

Partial or complete obstruction due to congenital or acquired cysts responds better to TURED.

4% of patients treated for partial EDO can become azoospermic after TURED.

Complications of surgery:

  • Watery ejaculate
  • Hematuria
  • Epididymitis
  • Rarely, incontinence and seminal vesiculitis

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