Though an uncommon cause of male infertility, EDO is an important one to diagnose because it is so treatable. Affected men will present with infertility most commonly, though they can also come to the urologist with complaints of pain with ejaculation or blood in the ejaculate. After taking a history and physical examination, the urologist should obtain a semen analysis, which will be significant for a low sperm count, poor sperm motility, and low ejaculate volume. The semen will often have an acidic pH. Not all of the above findings are present in all cases.
When EDO is suspected, the confirmatory test, the transrectal sonogram, can be performed by the urologist in the office and will likely show dilation of the seminal vesicles or the ejaculatory duct. Occasionally prostatic cysts or calcifications will be seen that support the diagnosis. In difficult to diagnose cases, an MRI may be helpful.
Treatment consists of surgically unroofing the blocked ducts with a simple, effective, outpatient procedure, the TURED. After a successful TURED, the majority of men will show improvement in counts, motility, volume, or any combination of the above in the first few weeks after treatment. Therefore, patients are counseled to resume unprotected sex or ART treatments within 1-2 weeks post-TURED.
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