Ejaculatory duct obstruction can be difficult to diagnose. The urologist should suspect the diagnosis in a patient who presentsfor infertility and has low ejaculate volumes and a low sperm count or no sperm at all (azoospermia).This person presented with urinary retention and in evaluating him for a procedure to alleviate his voiding problem, I did a prostate ultrasound.
I would give him a diagnosis of mega-seminal vesicles--or dilated seminal vesicles. Not all intances of seminal vesicle dilation is caused by ejaculatory duct obstruction and not all cases of ejaculatory duct obstruction have seminal vesicles that are this dilated on sonogram.
In fact, ejaculatory duct obstruction remains the most challenging diagnoses in urology and requires a combination of clnical suspicion, sonographic and laboratory finidings, and experience to make the diagnosis accurately.