[Congenital bilateral ejaculatory duct absence complicated with seminal vesicle cyst: a case report and review of the literature]

OBJECTIVE

To report a case of simple congenital bilateral ejaculatory duct absence (EDA) complicated with seminal vesicle cyst and review the relevant literature in order to improve the diagnosis and treatment of the disease.

METHODS

We retrospectively reviewed the clinical data of a case of bilateral congenital EDA complicated with seminal vesicle cyst, reviewed the relevant literature at home and abroad, and comprehensively analyzed the embryonic development, diagnosis, and treatment of congenital EDA.

RESULTS

The patient was a 23-year-old man, present at the clinic for infertility after married for a year. Vasography and other imaging examinations confirmed simple congenital bilateral EDA complicated with seminal vesicle cyst. Pathologic biopsy showed normal spermatogenic function of the testes.

CONCLUSION

Congenital EDA originates from embryonic developmental defect of the mesonephric duct, and it can be confirmed by vasography. Transurethral incision of the ejaculatory duct and intracytoplasmic sperm injection can be employed for the treatment of bilateral EDA.

[Congenital obstruction of the ejaculatory ducts: diagnosis and resolution of two successful cases]

The ejaculatory ducts obstruction is an uncommon finding in the study of infertility male factor. We present two cases referred to our department for conjugal infertility, with proven male factor (low ejaculate volume and azoospermia). On physical examination there was no abnormality in both patients. Imaging studies demonstrated intra-prostatic cystic structure, causing ejaculatory ducts dilation. We performed transurethral resection of the ejaculatory ducts. Semen analysis 3 months postoperatively showed 1 case of normalization and 1 case of improvement in sperm count parameters. The couple 1 couple has 2 children, without medical assisted reproductive techniques. The couple 2 had one pregnancy after Intracytoplasmic Sperm Injection, from the ejaculate. This diagnosis depends on a strong clinical suspicion and is of high importance, since this disease has effective surgical treatment. The authors aim to highlight the relevance of the assessment andrological when studying marital infertility.

Hybrid method of transurethral resection of ejaculatory ducts using holmium:yttriumaluminium garnet laser on complete ejaculatory duct obstruction

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.

Clinical and radiological evaluation of ejaculatory duct obstruction

Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. With the advent and increased use of transrectal ultrasonography and magnetic resonance imaging, abnormalities of the ejaculatory duct (ED) related to infertility have been diagnosed more frequently. Recently, with the increased awareness of functional obstruction of ED, reports have been focusing on the diagnosis of partial or functional EDO. We present 2 review of the ED pathologies, imaging modalities and treatment options.

Renal Aplastic Dysplasia and Ipsilateral Ectopic Ureter Obstructing the Seminal Via: A Possible Cause of Male Infertility

Few cases of unilateral renal agenesis associated with ipsilateral seminal vesicle ectasia or cyst have been reported. Two cases of unilateral renal aplastic dysplasia and ipsilateral ectopic ureter opening in the ejaculatory ducts associated with infertility secondary to bilateral obstruction of the seminal via are reported. Clinical and physical assessment including transrectal ultrasound and magnetic resonance imaging are proposed as a comprehensive algorithm for the diagnostic evaluation of the pelvic cystic masses.

Rare case of ectopic duplicated megaureter with dysplastic upper kidney moiety opening into ipsilateral ejaculatory duct

A rare case of left mesonephric duct malformation consisting of a duplicated ectopic megaureter opening into the ejaculatory duct and ipsilateral upper moiety cystic renal dysplasia is reported to increase awareness among urologists and radiologists of this entity. Magnetic resonance imaging has been shown to be an excellent diagnostic tool for tracking of the trajectory of the ectopic ureter, thereby obviating the need for other invasive diagnostic techniques and permitting surgical correction of the anomaly. The embryology, clinical features, and diagnostic and therapeutic aspects of this rare malformation are presented.

Müllerian duct remnant involving Wolffian system: a case report and literature review

A 14-month-old boy with repeated left acute epididymitis was admitted to our department. Ultrasonography detected a midline round cystic mass in a retrovesical region. This was easily opacified by cystourethrography and seen to have a free communication with the posterior urethra. Since urethroscopy revealed a passable orifice in the center of the verumontanum, while a cystic-wall biopsy specimen showed squamous epithelium, we considered this cystic lesion to be an enlarged prostatic utricle. Vasography showed that the bilateral vasa was implanted directly into this cystic lesion, and was the possible cause of his left epididymitis. Ligature of the left vas deferens was performed to prevent left epididymitis. An enlarged prostatic utricle involving the vasa is a rare presentation.

[Diagnosis and treatment of obstructive azoospermia]

There are two types of azoospermia, namely, obstructive and nonobstructive azoospermia. Urologists play a more important role in the former, because many patients of the former can expect spontaneous pregnancy after surgical reconstruction of the seminal tract. In this review, we discuss about the causes, diagnosis, and treatment of obstructive azoospermia. The treatment includes vasovasostomy, epididymovasostomy, and transurethral resection of the ejaculatory duct. Surgical outcomes in our series are also described. The urologist must take care that the obstructive-azoospermic patients do not undergo unnecessary assisted reproduction procedures.

Urethro-ejaculatory duct reflux during mictiocystography in an anatomically normal infant

A 7-month-old patient with a verified urinary tract infection showed an unusual mictiocystography finding of reflux via the right ejaculatory duct into the epididymis. Usually such reflux is associated with anomalies of the genitourinary tract. This case demonstrated that reflux may occur in healthy infants and that it may be clinically associated with urinary tract infections.

[Malformations of Wolffian duct derived male genital organs (epididymis, vas deferens, seminal vesicules, ejaculatory ducts)]

OBJECTIVES

To analyse embryological phenomena, in order to define a practical approach to management.

METHODS

The authors reviewed the files of eight boys with an abnormality of Wolffian duct derived genital organs, consisting of three cases of vas deferens agenesis, two of which were accompanied by homolateral renal agenesis, one case of ectopic vas deferens with contralateral renal agenesis, three cases of duplicated vas deferens and one congenital seminal vesicle cyst with renal agenesis.

DISCUSSION

Congenital malformations of the epididymis consist of cysts and agenesis or partial atresia. Cysts essentially raise a problem of differential diagnosis. Treatment is only required in the case of severe discomfort. Vas deferens agenesis is the commonest lesion, an incidental finding in children. An experimental treatment is proposed in adults. Duplications, interdeferential communications and deferentomegaly are much rarer lesions. Seminal vesicle cysts are well visualized by transrectal ultrasonography and should be treated surgically. Lastly, ejaculatory ducts may present urethroseminal reflux or may be ectopic.

CONCLUSION

The possibility of absent or ectopic vas deferens should be considered in the case of unilateral renal agenesis. Vas deferens agenesis justifies examination of the contralateral side and investigation to exclude renal agenesis. Congenital cysts of the epididymis only require surgery when they are symptomatic. The presence of ipsilateral renal agenesis should be investigated in the case of cystic dilatation of the seminal vesicle.

[A case of congenital ejaculatory duct obstruction]

We report a case of congenital ejaculatory duct obstruction treated successfully by transurethral incision. A 33-year-old man was referred for evaluation of primary infertility. His semen analysis showed volumes of 1.7 ml at average and azoospermia. Clinical examinations revealed right undescended testicle, absence of the left kidney and axial rotation of right kidney. Left vasogram showed dilated but intact seminal vesicle with no contrast material visible in the bladder. Following removal of right undescended testicle, transurethral incision of the left side of the prostatic urethral floor near the vermontanum was performed. Transurethral vesiculogram showed dilated but not cystic ejaculatory duct. Eight months postoperatively semen analysis showed a volume of 3.5 ml, a concentration of 61.3 x 10(6)/ml and motility rate of 51.8%. However, semen analysis 18 months postoperatively showed azoospermia again. After re-transurethral incision, his sperm concentration increased to 15.2 x 10(6)/ml. However, his wife didn't become pregnant yet.

[Blind ureter ending in ejaculatory duct. Report of a case]

OBJECTIVES

Herein we describe a case of an extremely uncommon malformation of the genitourinary system in a patient who had consulted for epididymitis.

METHODS

Patient evaluation included radiological examination, IVP, US, CT and DVG The latter method was essential in the diagnosis of the malformation.

RESULTS

The findings indicated left renal agenesis with blind left ureter opening to the ipsilateral ejaculatory duct, with severe deformity of the left seminal vesicle and ejaculatory duct.

CONCLUSIONS

Since the patient has no important symptoms at the present time, contrary to the widely accepted approach, surgery has not been performed due to the risk of causing an iatrogenic lesion.

Anomalous ureteral insertion in VATER syndrome complicating renal transplantation

We report a renal transplantation with uretero-ureterostomy to a normal ureter in a patient with VATER syndrome who had agenesis of the ipsilateral kidney. Anomalous insertion of the native ureter into the ejeculatory duct was subsequently identified when his post-operative course was complicated by an ureteric leak and hydronephrosis. To our knowledge, this anomaly has not been previously reported. Transplant function is now excellent following temporary percutaneous nephrostomy. Contrast delineation of genito-urinary anatomy is recommended, before utilizing existing anatomical structures in the urinary tract, in patients with VATER syndrome.

Lower genitourinary tract anomalies in a male with Down syndrome

A patient with Down syndrome is presented who had hypospadias, a large low implanted prostatic utricle, and refluxing ejaculatory ducts entering the utricle.

Unilateral absence of the scrotal vas deferens associated with contralateral mesonephric duct anomalies resulting in infertility: laboratory, physical and radiographic findings, and therapeutic alternatives

Ten patients who presented for infertility had unilateral absence of the scrotal vas deferens and a contralateral mesonephric duct anomaly, including contralateral ejaculatory duct or epididymal/vasal obstruction. The details of the physical examination, semen analysis and transrectal ultrasound led to an accurate preoperative diagnosis in each case. Therapeutic manipulations appropriate in this group included transurethral resection of the ejaculatory duct, microscopic vasoepididymostomy and microsurgical sperm aspiration coupled with in vitro fertilization. Only 3 patients had ipsilateral renal agenesis or ectopia (30%), which is well below the stated percentage for patients with unilateral vasal agenesis (90%). An aberration in the proper sequence of mesonephric embryological development may partly explain this bilateral constellation of abnormalities.

[A case report of an ectopic ureter in a patient treated for chronic prostatitis]

A male aged 20 had been treated for anal and lower abdominal pain after ejaculation for about 2 years under the diagnosis of chronic prostatis. Because of worsening of the pain, he was admitted to our hospital in September 24, 1991. On the rectal examination, a cystic tumor was palbable on the left side of the prostate. The left kidney was not detected by IVP and ultrasonography. CT revealed two retrovesical cystic lesions in the left side. Cystourethroscopy showed an absence of ureteral orifice and ureteral ridge on the left side. Left uretero-seminal vesiculectomy was performed on October 3rd, under the diagnosis of an ectopic ureter entering into the seminal vesicle or ejaculatory duct. Histopathologically, the left ectopic ureter entering into the lower portion of the seminal vesicle or ejaculatory duct and the left renal agenesis were diagnosed. It was remarkable that ureteral epithelium was not transitional but columnar epithelium.

Male infertility: role of transrectal US in diagnosis and management

Ultrasound (US) has become crucial in the assessment of infertility of couples, in 50% of whom the male partner is responsible. Male infertility is caused by many diverse conditions, from reparable obstructive disorders to noncorrectable intrinsic testicular failure. During the past 4 years, a select group of 70 young infertile men with azoospermia or oligospermia and low ejaculate volume were examined with transrectal US. Twenty-six patients had congenital bilateral absence of the vas deferens, 11 had congenital unilateral absence of the vas deferens and contralateral obstructive pathology, 15 had additional abnormalities thought to be directly related to semen deficiencies, and 18 patients with other causes for semen deficiency and infertility had findings that were either normal or showed minor abnormalities. The delineation of congenital and obstructive abnormalities of the distal urogenital tract with transrectal US enables an accurate diagnosis of certain cases of male infertility and helps guide appropriate clinical and surgical management.

The neodymium:YAG laser recanalization in a patient with azoospermia due to ejaculatory duct agenesis

A 32-year-old man with azoospermia is presented. Transperineal echographically guided vesiculography of the vas deferens showed absence of the ejaculatory duct and presence of a cystic müllerian duct in which both enlarged seminal vesicles joined. Transurethrally, by means of a contact tip over the verumontanum a new channel was created by neodymium:YAG laser irradiation at 25 watts every 2 seconds. The patient had 32.10(6) spermatozoa per ml. with good quality on semen analysis 10 months later.

[Ectopic opening of the ureter into the ejaculatory duct. Use of ultrasound-directed vesiculography in the diagnosis of this type of malformation]

We report a right mesonephric duct malformation consisting of an ectopic ureter opening into the ejaculatory duct, ipsilateral renal agenesia, ipsilateral seminal vesicle cyst, and contralateral renal malrotation. The diagnostic methods considered useful in this condition are described, including direct ultrasound-guided vesiculography, a technique which, in our experience, is easy to perform and has proved to be very useful.

Congenital anomalies of the seminal ducts

The frequency of individual congenital anomalies of the deferens, the seminal vesicles, the ejaculatory ducts and the utricle in 158 patients treated for sterility was determined by the method of deferentovesiculography by punction. Congenital anomalies were found in 14 patients (8.8%). Anomalies of rare occurrence are demonstrated in detail. The relation of such anomalies to sterility of patients is described.

Successful treatment of aspermia secondary to obstruction of ejaculatory duct

A case is reported of a patient with aspermia secondary to bilateral ejaculatory duct obstruction. Successful therapy was accomplished by use of the direct-vision urethrotome.

Two cases of ectopic ureter opening into the ejaculatory duct: double vas deferens revisited

We report 2 rare cases of single ectopic ureter simulating double vas deferens. Clinical, radiographic and macroscopic signs at operation indicated a single ectopic ureter opening into the seminal tract. However, histological examination of the surgical specimen revealed that the lumen of the supposed ureter was lined in part by columnar epithelium, although chiefly by transitional epithelium. The wall of the ureter contained 3 well defined muscular coats in case 1 but only 1 layer was distinguishable in case 2. Histological composition of the structure removed from the cranial site resembled that of the epididymis. A review of the literature revealed a few comparable cases. Analysis of these cases suggests that double vas deferens and a single ectopic ureteral opening into the seminal tract are such that their differentiation may only have semantic significance. We speculate that these 2 diseases are included as 1 entity, only to be distinguished by the difference of ureterization of the ureteral bud.

Sterility caused by functional absence of ejaculatory ducts

Five patients with functional absence of genital excretory ducts are presented, with emphasis on the scarcity of physical and complementary data obtained. The low impairment of spermatogenesis is pointed out. Seminal characteristics are analysed and the diagnostic importance of spermogram data stressed. The importance of the qualitative determination of fructose for the diagnosis of this syndrome is noted, as well as the incidence of this syndrome as the cause of azoospermia and sterility. The existence of a unilateral congenital absence of ejaculatory ducts is demonstrated. Cases of this sort cannot be detected unless a contralateral acquired lesion occurs.

Ejaculatory duct obstruction

The diagnosis, long-range pathophysiology and surgical approach to ejaculatory duct obstruction are presented. Of 5 cases 3 had epididymal extravasation from long-term pressure buildup and secondary epididymal obstruction. This is similar to the epididymal findings after long-term vasectomy.

Aspermia owing to obstruction of distal ejaculatory duct and treatment by transurethral resection

A case of a young aspermic male patient with bilateral atresia of the terminal ejaculatory duct is reported. He was treated successfully by transurethral resection of the prostate gland in the area of the ejaculatory ducts.

Cystic duplication of ejaculatory duct: case report

A case of complex malformation of the genito-urinary tract, including cystic dilatation and partial duplication of the ejaculatory duct is reported. The lesion was visible on retrograde and anterograde vasovesiculography; its complete removal was possible using an abdominal approach.

Congenital mesonephric defects in male infants with mucoviscidosis

Reports that men with mucoviscidosis were sterile and that portions of their genital tracts were atretic prompted us to investigate the genital tracts of 15 male infants with mucoviscidosis who died within the first year of life and came to necropsy. The genital tracts of all of these infants were abnormal, the abnormalities being confined to mesonephric derivatives. Hypoplastic or absent ducti efferentia, ducti epididymides, or ducti deferentia were found in all 28 specimens of epididymides, and the ducti deferentia were missing from 25 of 27 examples of spermatic cord. The seminal vesicles and the ejaculatory ducts were less frequently hypoplastic or absent. Because these abnormalities of mesonephric derivatives were present so early in life and inflammatory and obstructive changes were absent we believe that they resulted from a failure of development.