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    Urologists illustrate key steps in management of duct obstruction

    In the era of assisted reproduction, sperm retrieval with in vitro fertilization (IVF) appears to be the most straightforward approach to management of men with ejaculatory duct disorders who wish to conceive. Due to costs and some religious prohibitions associated with IVF, some couples may not wish to proceed to IVF. Typically, insurance companies will cover transurethral procedures for ejaculatory duct anomalies. Therefore, it is important for urologists to keep transurethral resection of the ejaculatory ducts (TURED) within their armamentarium. These three videos illustrate the key steps of TURED. This procedure, which is performed rarely, even by reproductive urologists, can enable some patients to get pregnant naturally or with intrauterine insemination where they would otherwise need IVF. The techniques illustrated here allow an optimal outcome with minimal morbidity. Specifically, they highlight the role of using methylene blue to allow precise identification of the ducts and transrectal ultrasound to visualize the relevant structures.

    —Ranjith Ramasamy, MD, and James M. Hotaling, MD, MS, Section Editor

     

    Commentary on the videos is provided by Ranjith Ramasamy, MD, director of male reproductive medicine and surgery and assistant professor of urology at the University of Miami, and 'Y'tube Section Editor James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.

    Continue to the next page to watch the videos.

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