Male factorEjaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation
Section snippets
Materials and methods
Between March and September 2005, 7 men, mean age 32 years, presented for evaluation of primary infertility. All were found to have EDO and ipsilateral renal anomalies. They underwent semen analysis, evaluation of hormone parameters (FSH, LH, testosterone), and TRUS. Semen analysis with sperm count, motility, and morphology (WHO, 1992), volume, pH, fructose, carnitine, and citrate were evaluated twice before surgery and in the third and sixth month after surgery. The colorimetric method was
Results
Before surgery, 5 of the 7 men had nonprojectile ejaculation and low ejaculate volume; 4 developed symptoms of dysuria, pain after ejaculation, and perineal pain; and 1 had referred genitourinary infections that required treatment with an antibiotic. None had hematospermia. All 7 patients had normal testicular size and consistency, with no indurations of epididymides secondary to obstruction. No dilated seminal vesicles were found at the rectal examination. They had semen volume <1.62 mL, with
Discussion
The seminal vesicles join with the vas deferens outside the prostate to form the ejaculatory ducts. Sperm normally pass through the vas deferens directly into the ejaculatory duct and drain bilaterally into the posterior urethra, with little or no reflux back into the seminal vesicles.
Anatomical studies have not demonstrated the presence of a valvular mechanism to prevent sperm from entering the seminal vesicles from the vasal ampulla as we showed through SVA 3, 4. Colpi et al. suggested that
Conclusions
Ejaculatory duct obstruction from cystic lesions of seminal vesicles is a treatable disease using a simple procedure such as TURED.
Even in the age of assisted reproductive procedures such as TESE (testicular sperm extraction), MESA (microsurgical epididymal sperm extraction), and ICSI (intracytoplasmatic sperm injection), it is important to diagnose obstructive azoospermia, which is potentially reversible.
Detecting EDO has become easier and less invasive with the development of high-resolution
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