The outcome of transurethral seminal vesiculoscopy regulated by Endoscopic Seminal Vesicle Milking Test in treating ejaculatory duct obstruction: A prospective cohort.

Purpose: This study aimed to evaluate the effectiveness of Endoscopic Seminal Vesicle Milking Test combined with seminal vesiculoscopy with a 4.5 Fr ureteroscope as a minimally invasive approach for diagnosing and treating ejaculatory duct obstruction while preserving ejaculatory function.

Materials and methods: A prospective cohort study was conducted, involving 19 male patients with suspected ejaculatory duct obstruction. Endoscopic Seminal Vesicle Milking Test was used for initial diagnosis & confirming obstruction, followed by seminal vesiculoscopy using a 4.5 Fr ureteroscope. Pre- and post-operative seminal parameters, complications, and conception rates were analyzed over one year.

Results: Among 19 patients, Endoscopic Seminal Vesicle Milking Test excluded 3 cases of functional obstruction, while 2 cases excluded due to lost follow-up. Among the 14 completing the protocol, 9 had successful sperm retrieval, with significant improvements in seminal parameters (volume: 1.96 ± 0.98 mL, concentration: 16.9 ± 18.4 million/mL, motility: 19.1 ± 11.7%). While in the other five patients, seminal vesiculoscopy failed to retrieve sperms. Hence, Vasography was performed and revealed obstructed vas deferens. Four patients achieved conception within a year. Minor complications included transient hematuria and hematospermia, with one case of recurrent epididymitis managed conservatively.

Conclusion: The combination of Endoscopic Seminal Vesicle Milking Test and seminal vesiculoscopy offers a promising, minimally invasive solution for ejaculatory duct obstruction, demonstrating favorable outcomes in sperm retrieval and conception rates with minimal complications. Further multicenter trials are recommended to validate these findings.