Ejaculatory duct obstruction in subfertile males: analysis of 87 patients

Abstract

Objective: To study the causes, presentation, and treatment of ejaculatory duct obstruction in subfertile males.

Design: Collaborative retrospective study of clinical experience collected by two urologists over a 15-year period.

Setting: National Health Service and Private Care Hospitals.

Patients, participants: Subfertile males with azoospermia (n = 67), very severe oligozoospermia (n = 17), oligozoospermia (n = 1), or normal sperm concentration (n = 2) in small volume ejaculates with acid pH and little or no fructose.

Interventions: Exploration of scrotum with vasogram and testicular biopsy, plus reconstruction if possible.

Main outcome measures: Follow-up seminal analysis and occurrence of pregnancy in female partners.

Results: The causes were: müllerian duct cyst (n = 17); wolffian duct malformation (n = 19); previous surgical trauma (e.g., imperforate anus) (n = 15); previous genital infection (n = 19); tuberculosis (n = 8); megavesicles (pathological dilatation of vesicles and ampullae of unknown cause) (n = 8); and carcinoma of prostate (n = 1). After incision of Mullerian duct cysts, five pregnancies were produced. Five pregnancies occurred in the other groups using a variety of surgical techniques.

Conclusions: Routine vasography has shown that ejaculatory duct obstruction is not as rare as previously thought. The diagnosis should not be missed because the condition is simple to correct surgically in certain cases.