Elsevier

Fertility and Sterility

Volume 89, Issue 2, February 2008, Pages 390-394
Fertility and Sterility

Male factor
Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation

https://doi.org/10.1016/j.fertnstert.2007.03.009Get rights and content

Objective

To report our experience with TURED in infertile men with EDO associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract.

Design

Retrospective clinical study.

Setting

Infertile men in an hospital environment.

Patient(s)

Seven patients affected by Zinner syndrome, from March to September 2005, were selected.

Intervention(s)

Underwent TURED.

Main Outcome Measure(s)

Semen analysis, endocrine profile, transrectal ultrasonography and seminal vesicles aspiration, excretory urography, computerized tomography (CT), or magnetic resonance imaging (MRI).

Result(s)

Before surgery, the patients experienced a decreased intensity and force of ejaculation and a low motile sperm count. The detection of the ipsilateral upper urinary tract malformation by the patients was incidental. After surgery, all patients reported having a projectile ejaculation, an increase in the average postoperative volume, and of the total motile sperm count.

Conclusion(s)

A seminal vesicle cyst combined with ipsilateral renal agenesis, described as Zinner syndrome, is a rare urological anomaly. It is frequently asymptomatic or else characterized by infertility, symptoms of bladder irritation, or pain in the scrotum and perineum. In selected patients, TURED can improve semen quality with subsequent ability to impregnate. The upper urinary tract malformation should be treated in symptomatic cases only.

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

References (15)

There are more references available in the full text version of this article.

Cited by (0)

View full text