Management of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy: Case Report and Literature Review

Azoospermia Due to Functional and Partial Ejaculatory Duct Obstruction: A Rare Case Report and Literature Review

Ejaculatory duct obstruction (EDO) is a rare but treatable cause of male infertility. This case report describes a 28-year-old male with obstructive azoospermia. The patient came to our hospital after a fertility check-up revealed azoospermia. A subsequent semen analysis confirmed azoospermia. Transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) revealed bilaterally enlarged seminal vesicles and thickened, calcified ejaculatory duct walls. The patient underwent transurethral seminal vesiculoscopy and transurethral resection of the ejaculatory ducts (TURED) for presumed partial EDO. Despite two transurethral seminal vesiculoscopy and TURED procedures, postoperative semen analysis still showed azoospermia. TRUS indicated non-contractile seminal vesicles and an unobstructed ejaculatory duct. The patient ultimately underwent percutaneous epididymal sperm aspiration for assisted reproductive technology and his spouse got pregnant. We identified a case of azoospermia caused by a rare combination of partial and functional ejaculatory duct obstruction. There are currently no reports of similar cases. This case report aims to provide valuable insights for diagnosing and treating EDO.

Painful Ejaculation - An Ignored Symptom

The purpose of this review is to summarize the pathophysiology of ejaculation and look into prevalence, aetiology, diagnosis, and treatment of painful ejaculation. We carried out a comprehensive search of PubMed in order to look for literature on male painful ejaculation using keywords post-orgasmic pain, painful ejaculation, dysejaculation, odynorgasmia, post-orgasmic pain, or dysorgasmia. Painful ejaculation has an alarming prevalence throughout the world, between 1 to 25%. It has a detrimental effect on patients' quality of life as it reduces individual self-esteem and is associated with sexual dysfunction. Its aetiology includes simple infection or inflammation of the urinary tract, benign prostate hyperplasia, ejaculatory duct obstruction, post-radical prostatectomy and side effects of certain medications. Once reported, it should be investigations and treatments should be tailored according to the etiology. Both medical and surgical treatment is available depending on the cause of painful ejaculation. Due to the sensitive nature of its presentation, it is a symptom that can be identified best when specifically asked. Our understanding regarding painful ejaculation is very limited and only a few articles have revealed insight into this topic. Further research is required in order to set proper guidelines for diagnosis and treatment of painful ejaculation.