[Diagnosis and treatment of obstructive seminal vesicle pathology].

Abstract

Ejaculatory duct(s) obstruction(s) (EDO) may be responsible for as much as one third of azoospermia- or severe oligospermia-related infertility; it's clinical presentation also includes some low urinary tract irritative symptoms, such as repeated epididymitis, pelvi-perineal pain, hematospermia and other ejaculatory disturbances. The diagnosis of EDO is based on patient's history, semen analysis (hypospermia, azoospermia, low fructose level), and transrectal ultrasound (TRUS), which can demonstrate seminal vesicle(s), vas ampulla(s) and/or ejaculatory duct(s) dilatation, Müllerian or utricular cyst, and ejaculatory duct(s) or seminal calcification(s). Confirmation of the suspected diagnosis, if needed, requires classical vasography or TRUS-guided seminal tract puncture and vesiculography. Treatment is usually successfully achieved with transurethral endoscopic procedures: retrograde ejaculatory duct(s) catheterisation, dilatation, incision or resection; seminal tract endoscopy is seldom performed. Very few complications occur; evaluation of long term results is lacking. Indications of such endoscopic procedures remain to be defined, especially in cases of partial EDO.