title: Less invasive causal treatment of ejaculatory duct obstruction by balloon dilation: a case report, literature review and suggestion of a CT- or MRI-guided intervention.
abstract: Uni- or bilateral ejaculatory duct obstruction (EDO) is a rare but correctable cause of infertility, chronic pelvic pain and postejaculatory pain. EDO is a congenital or acquired condition, it is the underlying cause of infertility in approximately 5% of infertile men. If acquired, the etiology often remains unresolved, but prostatitis or urethritis with post-inflammatory adhesion of the duct walls seems to be a common underlying pathomechanism.Although a certain constellation of physicochemical semen parameters may lead to correct diagnosis, EDO often resembles a diagnosis by exclusion. Imaging of acquired EDO remains a challenge and the established surgical therapy, transurethral resection of the ejaculatory ducts (TURED), leads to a low rate of natural conception and a high rate of complications such as reflux of urine and epididymitis. We present a case of a male with suspected EDO who underwent a combined approach to both, semi-invasive diagnosis and therapy by transrectal puncture of the seminal vesicles and antegrade balloon-dilation of the ejaculatory ducts. Possibilities and pitfalls of this procedure are described and the literature is reviewed.Furthermore, we suggest a CT- or MRI-guided, percutaneous intervention for treatment of ejaculatory duct obstruction by balloon dilation and demonstrate initial steps of this procedure with a body donor. We call this new procedure PTED (percutaneous transgluteal ejaculatory ductoplasty).
authors.affiliation: Department of Radiology, University Hospital Schleswig-Holstein, Kiel, Germany. o.kayser@rad.uni-kiel.de
authors.forename: Ole
authors.initials: O
authors.lastname: Kayser
authors.forename: Daniar
authors.initials: D
authors.lastname: Osmonov
authors.forename: Jonas
authors.initials: J
authors.lastname: Harde
authors.forename: Guido
authors.initials: G
authors.lastname: Girolami
authors.forename: Thilo
authors.initials: T
authors.lastname: Wedel
authors.forename: Philipp
authors.initials: P
authors.lastname: Schäfer
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D002404:Catheterization / Q000379:methods*; D003251:Constriction, Pathologic / Q000628:therapy; D004543:Ejaculatory Ducts / Q000473:pathology*; D005832:Genital Diseases, Male / Q000628:therapy*; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed