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    Urologists illustrate key steps in management of duct obstruction


    Surgical management of ejaculatory duct obstruction due to prostatic utricular cyst - Phil V. Bach, MD, and Marc Goldstein, MD, DSc





    Obstructive azoospermia accounts for approximately 40% of azoospermia cases and can be caused by a blockage anywhere along the male reproductive tract. Five percent of OA cases are secondary to ejaculatory duct obstruction (EDO), which may be caused by a variety of congenital or acquired etiologies. The mainstay of management for ejaculatory duct obstruction is transurethral resection of the ejaculatory ducts. We present the case and surgical management of a man with primary infertility secondary to EDO caused by a prostatic utricular cyst.

    Dr. Ramasamy: When transrectal aspiration of the seminal vesicle fluid after ejaculation identifies sperm on wet prep /microscopy, EDO can be diagnosed. Sperm should typically not be present within the seminal vesicle unless there is a distal obstruction. Drs. Bach, Goldstein, and colleagues demonstrate the utility of vasogram in confirming the diagnosis of EDO. A vasogram should be performed only in the setting where microsurgical reconstruction is possible and when anatomy of the vas/seminal vesicles is poorly defined. A resection loop can be used to resect the verumontanum to expose the underlying ejaculatory ducts or prostatic utricle.

    Dr. Hotaling: Here Dr. Li and colleagues illustrate the diagnostic workup of men with obstructive azoospermia in the setting of EDO. They also summarize the literature in the field. The technique for a vasogram is also illustrated, which can be a useful part of this procedure.

    Phil V. Bach, MDPhil V. Bach, MD Marc Goldstein, MD, DScMarc Goldstein, MD, DSc

    Dr. Bach is an instructor in urology and fellow in male reproductive medicine and surgery at Weill Cornell Medicine, and Dr. Goldstein is the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College of Cornell University; surgeon-in-chief, male reproductive medicine and Surgery, and director of the Center for Male Reproductive Medicine and Microsurgery at the New York Presbyterian Hospital Weill Cornell Medical Center, New York.


    Section Editor James M. Hotaling, MD, MSSection Editor James M. Hotaling, MD, MS

    Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.

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