Ejaculatory Duct Obstructon

	The ejaculatory duct is the conduit that carries the semen into the urethra (the tube in the penis). Symptoms associated with ejaculatory duct obstruction are extremely variable and there may be no symptoms at all. Men may complain of a decrease in the projectile nature of their ejaculate. Occasionally vague discomfort is noted in the area between the scrotum and anus. A common abnormality found is decreased ejaculatory volume. Sperm counts are variable and motility is often affected. Prior infections of the urinary tract including prostatitis and epididymitis are risk factors predisposing to obstruction. Any history of urologic surgery (bladder, prostate, urethra) may also be significant. Men with suspected ejaculatory duct blockage may undergo a transrectal ultrasound. This is a procedure done in the office,in which an ultrasound probe is placed in the rectum. The probe is approximately the size of a finger and the test is comparable to a rectal exam. The ultrasound will show evidence of obstruction. If obstruction is present, transurethral resection of the ejaculatory ducts should be performed. This is done in the operating room under anesthesia and on an outpatient basis. A small telescope is placed into the urethra and an incision is made into the ejaculatory duct. No outside visible incision is noted after this procedure. A catheter may be required for one to two days postoperatively. Blood may also be noted in the urine postoperatively or present in the ejaculation. The patient should refrain from sexual activity for one week. One month after the procedure a semen analysis is performed. One can expect a 50 to 80% chance of improvement in semen quality, and if semen quality is improved then approximately a 50% pregnancy rate. As in any type of surgery, there are risks of bleeding and infection. Complications of this procedure are rare and include scarring which may re-occlude the ejaculatory duct requiring a repeat incision. Retrograde ejaculation (semen traveling into the bladder) or dribbling after voiding may also occur.

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