Transurethral resection of ejaculatory ducts (TURED) for the management of ejaculatory duct obstruction: a Saudi cohort

This retrospective study aimed to investigate the clinical characteristics, changes in semen parameters, and outcomes of adult patients with ejaculatory duct obstruction (EDO) who underwent transurethral resection of ejaculatory ducts (TURED). The study included 25 patients diagnosed with EDO who underwent TURED at King Faisal Specialist Hospital & Research Center in Saudi Arabia between January 2015 and December 2021. The results showed that 68% of the patients had complete ED obstruction, while 32% had partial obstruction. Primary infertility was reported in 68%of the patients, with 4% experiencing secondary infertility. The analysis revealed a significant increase in semen volume greater than 0.6 after TURED, while there was a significant decrease in volumes ranging from 0.1 to 0.3 and from 0.4 to 0.6. Patients with partial ED obstruction demonstrated a significant improvement in semen parameters compared to those with complete ED obstruction. The findings suggest that TURED is a safe and effective treatment option for EDO, leading to significant improvements in semen parameters and potentially resulting in spontaneous pregnancy. However, further research is needed to identify specific patient subgroups that may benefit the most from TURED. While magnetic resonance imaging (MRI) with an endorectal coil has been proposed for more detailed evaluation, transrectal ultrasound (TRUS) has been suggested as the standard examination technique.

Transurethral resection; Ejaculatory duct obstruction; Infertility; Azoospermia; Assisted reproductive technology

[1] Farley S, Barnes R. Stenosis of ejaculatory ducts treated by endoscopic resection. Journal of Urology. 1973; 109: 664–666.

[2] Visser WR, Smith-Harrison LI, Krzastek SC. Surgical procedures for male infertility: an update. Current Opinion in Urology. 2021; 31: 43–48.

[3] Shen H, Liao K, Wu W, Li G, Chen S, Nan N, et al. Case report: mucinous adenocarcinoma arising from congenital ejaculatory duct cyst. Pathology and Oncology Research. 2021; 27: 528050.

[4] Johnson CW, Bingham JB, Goluboff ET, Fisch H. Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms. BJU International. 2005; 95: 117–119.

[5] Yurdakul T, Gokce G, Kilic O, Piskin MM. Transurethral resection of ejaculatory ducts in the treatment of complete ejaculatory duct obstruction. International Urology and Nephrology. 2008; 40: 369–372.

[6] Lv KL, Sun WG, Zhang TB, Zheng T, Nan YH, Liu YF, et al. Efficacy analysis of 26 cases of ejaculatory duct obstruction treated by prostatic utricle neck endoscopy. Frontiers in Surgery. 2022; 9: 1031739.

[7] Ren Z, Yang B, Lu D, Liu S, Yang L, Wang LC, et al. Transurethral resection of ejaculatory duct combined with seminal vesiculoscopy for management of persistent or recurrent hemospermia in men with ejaculatory duct obstruction. BMC Urology. 2020; 20: 34.

[8] Wang HB, Zhao LM, Hong K, Mao JM, Liu DF, Lin HC, et al. Transurethral seminal vesiculoscopy in treatment of oligoastheno-zoospermia secondary incomplete ejaculatory duct obstruction: a report of 8 cases. Journal of Peking University Health Sciences. 2020; 52: 642–645. (In Chinese)

[9] Tu XA, Zhao LY, Zhao L, Wang WW, Deng LW, Chen Y, et al. Efficacy of transurethral resection of ejaculatory duct for treatment of ejaculatory duct obstruction: report of 60 cases. Journal of Peking University. 2011; 43: 559–561. (In Chinese)

[10] Abdel-Al I, Elatreisy A, Hassan GM, Gharib TM. Long-term success durability of transurethral resection of ejaculatory duct in treating infertile men with ejaculatory duct obstruction. Journal of Endourology. 2022; 36: 982–988.

[11] Pippa Sangster, Ayo Kalejaiye, Giovanni Chiriaco, Amr Raheem, Asif Muneer, David Ralph. Presentation and treatment outcomes of ejaculatory duct obstruction. 2023. Available at: https: //university.auanet.org/abstract_detail.cfm?id=MP89-13&meetingID=17BOS (Accessed: 19 June 2023).

[12] Popken, Wetterauer, Schultze-Seemann, Deckart, Sommerkamp. Transurethral resection of cystic and non-cystic ejaculatory duct obstructions. International Journal of Andrology. 1998; 21: 196–200.

[13] Rodrigues Netto N, Esteves SC, Neves PA. Transurethral resection of partially obstructed ejaculatory ducts: seminal parameters and pregnancy outcomes according to the etiology of obstruction. Journal of Urology. 1998; 159: 2048–2053.

[14] Mei CE, Hu JC, Li JR, Chiu KY, Wang SS, Chen CS. Intraoperative calculus or hemorrhage in transurethral seminal vesiculoscopy as a risk factor for recurrent hemospermia. PLOS ONE. 2022; 17: e0268314.