葉志胤、莊光達

新光吳火獅紀念醫院 外科部 泌尿科

Chih-Yin Yeh, Guang-Dar Juang

Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital

       

Abstract:

Ejaculatory duct obstruction (EDO) presents with infertility, pain, or hematospermia. Etiologically it can be either congenital or acquired. The diagnosis of EDO mainly depends on history, physical examination and semen analysis. The semen of EDO patients is characterized by low ejaculate volume, oligospermia or azoospermia. Transrectal ultrasound has replaced formal vasography as the first-line diagnostic test but is not specific. Transurethral resection of the ejaculatory ducts (TURED), as the standard surgical method of treatment for EDO, and is effective for most of the patients.

We present a 65 year-old male suffered from ejaculatory pain with low or no semen volume for more than 10 years. Post-ejacualtion pain was chief complained and beading vas was palpable on physical examination. He also complained of suprapubic pain or orchialgia occasionally. Transrectal ultrasound revealed dilated right ejaculatory duct with cystic formation just in the verumontanum and dilated both seminal vesicles. Magnetic resonance imaging (MRI) showed ejaculatory duct obstruction and seminal vesicle enlargement. TURED revealed the dilated ejaculatory duct orifice and cyst cavity below the verumontanum. Large amount of semen-like fluid flew from the ejaculatory duct during operation.      The pain on ejaculation disappeared following treatment. The literature will be reviewed.