Ejaculatory duct obstruction is a rare but important cause of male infertility. The differential diagnosis, evaluation and treatment of patients with suspected ejaculatory duct obstruction is described herein. New minimally invasive techniques that can be utilized in both the diagnosis and treatment of ejaculatory duct obstruction are described.
Catheterization ; Ejaculatory Ducts ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Infertility, Male ; diagnostic imaging ; physiopathology ; therapy ; Male ; Ultrasonography

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.
Adult ; Azoospermia/diagnosis/physiopathology/surgery ; Ejaculatory Ducts/abnormalities/*surgery/ultrasonography ; Holmium ; Humans ; Infertility, Male/physiopathology/*surgery ; Laser Therapy/*methods ; Male ; Treatment Outcome ; Urethra ; Yttrium

OBJECTIVETo discuss the value of pre-operative semen analysis of patients with varicocele as a predictive restore index of sperm motility and fertilizing capacity after varicocelectomy.

METHODSSemen analysis was carried out with computer-aided sperm analyzer in 107 patients with varicocele and all patients were referred to the clinic with diagnosis of male infertility. Stratification of patients as group A (n = 32), B ( n = 36) and C (n = 39) was based on pre-operative total motile sperm count (TMSC). Follow-up included semen analysis and pregnancy data after three months following left or bilateral varicocelectomy.

RESULTSThe average post-operative TMSC increased significantly when compared with the pre-operative. However, a mean absolute increase in group A and B was better than that in group C (P < 0.05). Of the 68 patients in groups A and B based on pre-operative TMSC, 56 patients' TMSC (82.4%) was > or =20 x 10(6) after varicocelectomy, and that of only 8 (20.5%) patients in group C was > or =20 x 10(6) following varicocelectomy. Of the 98 patients wives, 36 had natural conception. Pregnancy rates in groups A and B were higher than that in group C (P < 0.05).

CONCLUSIONVaricocelectomy may be the most effective method to patients with varicocele with pre-operative TMSC > or = 5 x 10(6), but it may be not the best method for patients with severe oligoasthenospermia (pre-operative TMSC < 5 x 10(6)).

Adult ; Female ; Follow-Up Studies ; Humans ; Infertility, Male ; physiopathology ; surgery ; Ligation ; Male ; Pregnancy ; Pregnancy Rate ; Semen ; physiology ; Sperm Count ; Sperm Motility ; Varicocele ; physiopathology ; surgery

Male infertility due to obstructive azoospermia is a well-known entity. It is characterised by obstruction to the outflow of sperms either in the epididymis, vas, seminal vesicles or the ejaculatory ducts. We describe a rare case of obstructive azoospermia due to compression of the ejaculatory duct and seminal vesicle by a large lower ureteric stone in a 30-year-old man who had infertility for the past ten years. The patient's azoospermia resolved after removal of the stone.
Adult ; Azoospermia ; diagnosis ; etiology ; therapy ; Constriction, Pathologic ; diagnosis ; Ejaculatory Ducts ; physiopathology ; Humans ; Infertility, Male ; diagnosis ; etiology ; therapy ; Male ; Seminal Vesicles ; physiopathology ; Sperm Count ; Tomography, X-Ray Computed ; Ureteral Calculi ; complications ; diagnosis ; surgery