title: An update on the diagnosis and management of ejaculatory duct obstruction.
abstract: Ejaculatory duct obstruction (EDO) remains a rare but surgically correctable cause of male sexual dysfunction and male infertility due to obstructive azoospermia, diagnosed in up to 5% of infertile men. EDO should, therefore, be considered within the list of differential diagnoses for men undergoing infertility investigations, with work up including clinical examination, transurethral ultrasonography, semen analysis, chromotubation, seminal vesiculography and seminal vesicle aspiration. Obstruction can be limited to the distal ends of the ducts or it can extend proximally to include the terminal portions of the vasa deferentia, with the site and length of the obstruction having implications for surgical intervention. Early endoscopic treatment can reverse symptoms and prevent the progression of partial obstruction to bilateral, complete obstruction, and transurethral resection of the ejaculatory duct remains the main treatment option for EDO. Alternative treatment options include endoscopic laser-assisted resection of the ducts, antegrade seminal-vesicle lavage to relieve EDO secondary to inspissated material or calculi, or dilatation of the ejaculatory ducts using 9F seminal vesicoscopy or balloon.
authors.affiliation: Department of Urology, Worcestershire Acute Hospitals NHS Trust, Alexandra Hospital, Woodrow Drive, Redditch B98 7UB, UK.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Modgil
authors.affiliation: Department of Urology, Harrogate District Hospital, Lancaster Park Road, Harrogate HG2 7SX, UK.
authors.forename: Sonpreet
authors.initials: S
authors.lastname: Rai
authors.affiliation: Department of Andrology, University College London Hospital, 250 Euston Road, London NW1 2PG, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
authors.affiliation: Department of Andrology, University College London Hospital, 250 Euston Road, London NW1 2PG, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Muneer
mesh_terms: D000818:Animals; D019468:Disease Management; D004543:Ejaculatory Ducts / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D055101:Semen Analysis / Q000379:methods