Condition & Treatments
/ Ejaculatory duct obstruction
Ejaculatory duct obstruction: a blockage that can often be opened
The ejaculatory ducts are two small tubes inside the prostate that carry sperm and seminal fluid into the urethra. If they are blocked, sperm can't get out. It is uncommon, but it is one of the few causes of a zero or very low sperm count that can be fixed with a short operation.
I N S H O R T
The tell-tale signs are a low semen volume and acidic pH, with no sperm or very few sperm.
It is diagnosed with a transrectal ultrasound scan of the prostate and seminal vesicles.
Opening the ducts (TURED) can restore sperm to the semen and allow natural conception
Signs and causes
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Low semen volume, sometimes with pain on ejaculation or blood in the semen.
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Causes include a cyst in the middle of the prostate, past infection or inflammation, scarring, or small stones.
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Blockage can be complete, or partial, with a low but present sperm count.
Further imaging such as MRI in selected men
Treatment options
Transurethral resection of the ejaculatory ducts (TURED). A telescope is passed through the urethra under general anaesthetic, and the blocked ends of the ducts are opened. A day case or overnight stay.
Cyst aspiration, when a cyst is the cause.
Sperm retrieval with IVF/ICSI, if surgery is not suitable or doesn't work.
Why this matters to your care
Ejaculatory duct obstruction was the subject of Prof Raheem's PhD, a joint study between Cairo University and UCL on transrectal ultrasound in its diagnosis and treatment. He performs TURED himself. Accurate diagnosis matters, because the operation only helps when a true blockage is present. He has presented his own treatment outcomes for ejaculatory duct obstruction at international sexual medicine congresses.
Common questions
How successful is TURED?
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In a systematic review of 517 men, semen volume improved in a median of 83%, and around 1 in 4 couples conceived naturally. Results are best when the blockage is partial or caused by a cyst [1]. Prof Raheem's own results are in line with these published figures
What are the risks?
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These include watery semen, urine flowing back into the ducts, infection of the epididymis, and the blockage returning. Prof Raheem will go through them with you.
How soon will sperm come back?
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In successful cases, sperm returns to the semen straight away, so a semen test can be done soon after the operation. This is much faster than after an epididymovasostomy, where it can take up to a year.
Prof Raheem's published work on this topic
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Value of transrectal ultrasound in the diagnosis of chronic prostatovesiculitis in infertile men. Medical Journal of Cairo University, 2015. Ultrasound imaging of the infertile male (book chapter).
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Male Infertility in Reproductive Medicine. CRC Press, 2019.
References
. Mekhaimar A, et al. A systematic review of transurethral resection of ejaculatory ducts for the management of ejaculatory duct obstruction. Urology Research and Practice, 2020;46(5). Link