A Minimally Invasive Treatment for Ejaculatory Duct Obstruction
During normal ejaculation, sperm is transported from the vas deferens into the ejaculatory ducts within the prostate. After the seminal vesicles contract behind the prostate, the semen is forced into the urethra, through which men urinate and ejaculate. But if the sperm-carrying ejaculatory ducts are missing or blocked, sperm cannot reach the ejaculate and azoospermia and infertility results.
If you are experiencing infertility and have been diagnosed with low ejaculate volumes and azoospermia, it may be because you were born missing the ejaculatory ducts, or because the ducts are blocked due to cysts, calcification or stones. This blockage is known as ejaculatory duct obstruction (EDO), and in addition to infertility problems, it can also cause painful ejaculation and blood in the ejaculate (hematospermia).
Dr. Turek has described and treated two types of ejaculatory duct obstruction: partial and complete. As outlined in the table, complete obstruction is characterized by low semen volume and no sperm present. Partial obstruction is characterized by low-normal semen volume and low sperm counts and motility. Either type of obstruction can lead to severe male infertility. A third condition, termed “functional” obstruction, shows similar semen analysis findings, but on close evaluation reveals no evidence of a blockage. In this case, the system is dysfunctional with poor emptying of semen into the urethra. In such cases, medical therapy can be used to stimulate better function.
Classification of Ejaculatory Duct Obstruction By Semen Analysis
|Incomplete or Partial||Complete||Functional|
|Ejaculate volume||Low or Low-normal||Low||Low|
|Sperm count||Low||Absent||Absent or low|
|Sperm motility||Low||Absent||Absent or low|
|Ejaculate fructose||Present||Absent||Absent or low|
EDO is unusual but very treatable. Dr. Paul Turek, a board-certified urologist and men’s sexual health expert at The Turek Clinic, has pioneered minimally invasive techniques to treat the condition, and has written and published extensively about his work. Dr. Turek’s preferred approach is transurethral resection of the ejaculatory ducts (TURED), a one-hour surgical procedure performed through the penis.
Your prognosis after TURED is very good. Based on Dr. Turek’s published findings, at least 75 percent of men who undergo TURED will achieve a significant improvement in semen quality, and at least a 30 percent pregnancy rate can be expected.
When Is TURED Recommended?
TURED is recommended after a comprehensive history and physical examination and semen and ultrasound tests confirm EDO.
Transrectal ultrasound (TRUS) is the workhorse medical tool used to help diagnose suspected cases of EDO. It can reveal dilated seminal vesicles, cysts blocking the ejaculatory ducts or calcifications in the ducts. But, as Dr. Turek’s research has shown, TRUS alone is not sufficient to make the diagnosis in many cases. He has found TRUS to be very good at suggesting that obstruction is present, similar to a taking a snapshot picture with a camera. However, it should be used in combination with other diagnostic techniques that provide a more “dynamic” image of the system to make a truly accurate diagnosis. These adjunctive techniques include seminal vesicle sperm aspiration, TRUS-guided seminal vesiculography, ejaculatory duct chromotubation and ejaculatory duct manometry.
TURED At a Glance
TURED is the mainstay of treatment for EDO. The outpatient procedure is performed under general or regional anesthesia. During TURED, Dr. Turek passes an instrument called a cystoscope through the urethra to visually examine the inside of the urethra and bladder. Guided by a transrectal ultrasound to ensure precision and accuracy, he removes tissue from the verumontanum, a hump of tissue in the urethra near the ejaculatory ducts. Given the sophisticated techniques used to diagnose complete or partial blockage of the ejaculatory ducts, Dr. Turek can perform TURED on both sides or just on one side (hemi-TURED) to cure the problem.
Recovering from the Procedure
After the come and go procedure, a small catheter is placed in the bladder for 24 hours and removed in our office the next day. You can resume intercourse after several days.
Two weeks after the procedure, we perform the first formal semen analysis, and continue these tests at regular intervals until semen quality stabilizes.
In very rare cases, patients with partial blockages may lose their sperm count and become azoospermic (4 percent) after TURED because of scar formation. For this reason, Dr. Turek may recommend sperm banking prior to TURED. He will explain this option with you during the pre-operative consultative phase.
Learn More about TURED
If you are experiencing infertility or other symptoms due to EDO, TURED can help you overcome these problems. To learn more about the procedure and discuss your candidacy, please request an appointment with Dr. Paul Turek at The Turek Clinic today.