Ejaculatory duct obstruction

Ejaculatory duct obstruction refers to the congenital or acquired obstruction of the ejaculatory ducts.

Epidemiology

Ejaculatory duct obstruction is rare, accounting for approximately 5% of infertile patients, but thought to be underdiagnosed ².

Clinical presentation

Patients may complain about oligospermia, aspermia, chronic perineal pain worsened by ejaculation, and rarely from infertility.

Pathology

Complete or partial obstruction of the ejaculatory ducts may be a congenital anomaly such as ejaculatory duct atresia, but can also be acquired, secondary to urogenital infections, urethral trauma or iatrogenic e.g. postoperative

Radiographic features

Fluoroscopy

Vasography was once the only way to confirm ejaculatory duct obstruction, but it is no longer performed since new less invasive techniques are available such as transrectal US and MRI.

US

Transrectal ultrasound is the modality of choice for the assessment of ejaculatory duct patency.
Ejaculatory duct obstruction criteria described on ultrasound are ³:

• seminal vesicle dilatation: width >15 mm
• distension of the ejaculatory duct upstream of the obstacle
• prostate midline cystic lesions
• stones or calcification within the ejaculatory ducts or the verumontanum

MRI

MRI can be performed and demonstrates seminal vesicular dilatation.
Midline cystic lesions of the prostate may be associated.

Treatment and prognosis

Transurethral resection of the ejaculatory duct is the standard surgical technique, but new less invasive methods are described such as recanalization and balloon dilatation after transrectal US-guided seminal vesiculography ².