An In-Depth Overview About Ejaculatory Duct Obstruction
Ejaculatory duct obstruction (EDO) is a pathological disorder defined by the occlusion of one or both ejaculatory ducts. Thus, the outflow of (most elements of) semen is not conceivable.
It may be congenital or acquired. It is a cause of male infertility and pelvic discomfort. Ejaculatory duct blockage must not be confounded with an obstruction of the vas deferens.
An In-Depth Overview About Ejaculatory Duct Obstruction
Causes
Aspermia/azoospermia is a kind of male infertility that occurs when both ejaculatory ducts are fully clogged in an afflicted man. It is possible for them to suffer from a low volume of semen that lacks the gel-like fluid of the seminal vesicles or from no semen at all while experiencing the sensation of an orgasm, during which they will experience involuntary contractions of the pelvic musculature, during which they will be able to pass urine. This is in contrast to the behavior of several other types of anejaculation.
As a bonus, it has been a source of pelvic discomfort, particularly immediately after ejaculation. Pelvic pain may be caused by either partially obstructed ejaculatory ducts in the case of proven fertility but unresolved pelvic pain. In the case of proven fertility but unresolved pelvic pain, even one or both partially obstructed ejaculatory ducts may be the source of pelvic pain and oligospermia.
Ejaculatory duct obstruction can result in either a complete lack of semen (aspermia) or very low-volume semen (oligospermia), which may contain only the secretion of accessory prostate glands located downstream of the orifice of the ejaculatory ducts. Ejaculatory duct obstruction can also result in a complete lack of semen (aspermia) or very low-volume semen (oligospermia)
The blockage may be acquired owing to an infection produced by chlamydia, prostatitis, TB of the prostate, and other pathogens, in addition to the congenital type, which is often caused by cysts of the müllerian duct.
Furthermore, it has been noted that calculus may mechanically obstruct the ejaculatory duct, resulting in sterility. On the other hand, many patients have no prior history of inflammation, and the underlying reason is just unclear at this point in time.
Diagnosis
Occlusion of the seminal vesicles, which are responsible for the majority of the volume of the semen, results in low-volume, runny/fluid sperm (oligospermia), or no sperm at all (dry ejaculation/aspermia). Most of the time, men will be able to witness a runny/fluid, low-volume sperm on their own during masturbation.
Because the seminal vesicles contain a viscous, alkaline fluid rich in fructose, a chemical study of the semen of afflicted men will reveal a low fructose content and a low pH. Aspermia/azoospermia will be discovered by microscopic examination of the sperm.
A semen analysis, on the other hand, will demonstrate aspermia/azoospermia, as well as an almost average amount of semen, since the outflow of the seminal vesicles is not inhibited if both vasa deferentia are clogged (which may be the outcome of deliberate sterilization).
In part, this is because the gel-like fluid originating from the seminal vesicles accounts for approximately 80 percent of the volume of the semen while the fraction from the testicles/epididymis, which contains the spermatozoa, only accounts for about 5–10 percent of the importance of the semen
Furthermore, suppose a blockage of the vasa deferentia is the source of the azoospermia. In that case, the fructose concentration in the semen will be expected as well, since the fructose is predominantly derived from the fluid stored in the seminal vesicles and not from the bloodstream.
If the seminal vesicles contain spermatozoa but the semen does not, the obstruction must be downstream of the seminal vesicles, and the ejaculatory ducts are very likely to be obstructed, assuming that other causes of dry ejaculation/aspermia, such as retrograde ejaculation, have been ruled out as a possibility.
Attempts are occasionally attempted to detect an ejaculatory duct blockage using medical imaging, such as transrectal ultrasonography or magnetic resonance imaging (MRI), or by transrectal needle-aspiration of the seminal vesicles.
As a result, transrectal ultrasound is only helpful in ruling out cysts in the region of the orifices and is not sufficient to rule out an obstruction of the ejaculatory ducts due to other causes.
Transrectal ultrasound is not recommended for pregnant women or those planning to become pregnant. In around half of all instances of unexplained low-volume azoospermia, the cause is unknown.
Because it is difficult to detect changes in a restricted, scarred duct with these imaging modalities, MRI and TRUS do not disclose any abnormal signs in this situation.
Patients with ejaculatory duct blockages typically have enlargement of the seminal vesicles due to the obstruction of the ejaculatory ducts.
However, once again, neither the presence of normal-sized seminal vesicles nor the absence of a blockage of the ejaculatory ducts establishes a definitive diagnosis of obstruction.
Ejaculatory duct obstruction Treatment
Transurethral resection of the ejaculatory ducts is a procedure that may be used to address ejaculatory duct occlusion (TURED). […]
This operational treatment is highly invasive, has some severe consequences, and has resulted in spontaneous pregnancies in their partners in around 20% of males who have had this surgery.
The loss of the valves at the entrances of the ejaculatory ducts into the urethra, which allows urine to flow backward into the seminal vesicles, is a downside of the procedure.
Another experimental strategy is the recanalization of the ejaculatory ducts by using a balloon catheter that is implanted transrectally or transurethrally.
Even though it is far less intrusive and preserves the structure of the ejaculatory ducts, this treatment is not without risks and is not without unclear success rates. The success rate of recanalization of the ejaculatory ducts via balloon dilation is now being investigated in clinical research underway in Japan.
Most affected men have an average production of spermatozoa in their testicles, which means that after spermatozoa were harvested directly from the testicles, for example, by TESE, or from the seminal vesicles (by needle aspiration), they and their partners are potential candidates for some assisted reproductive treatment options, such as in-vitro fertilization.
It is important to note that in this instance, the majority of the therapy (such as ovarian stimulation and transvaginal oocyte extraction) is passed to the female spouse.
