Transurethral resection of the ejaculatory ducts for treating ejaculatory symptoms

OBJECTIVES To report our experience with transurethral resection of the ejaculatory ducts (TURED) in infertile men with symptomatic ejaculatory duct obstruction (EDO). PATIENTS AND METHODS We retrospectively reviewed the operative cases of one urologist from 1995 to 2001, identifying 15 patients with symptomatic EDO who underwent TURED. These men had normal hormone levels and no other known genitourinary dysfunction. Investigations included a history, physical examination, semen analysis, semen culture, and high-resolution transrectal ultrasonography. Responses to focused questions and semen analysis were evaluated after surgery. RESULTS Before surgery, all patients complained of a decrease in the volume of their ejaculate, 14 of 15 had a non-projectile ejaculation, nine had a genitourinary infection necessitating antibiotic treatment, and five had pain with orgasm. The mean ejaculate volume and total motile sperm count was 1.1 mL and 8.1 million sperm per ejaculate. After surgery, at a mean follow-up of 2 months, 10 men reported having projectile ejaculation, and eight reported a marked improvement in their sensation of orgasm. Overall, 14 men reported a subjective improvement in their ejaculation. The average postoperative ejaculate volume was 2.3 mL and the total motile sperm count was 38.1 million per ejaculate. CONCLUSIONS Men with symptomatic EDO who underwent TURED showed improvements in their ejaculation, sensation of orgasm, semen analysis values and fertility.