What is the ejaculatory duct?
The ejaculatory duct is the conduit that carries the semen into the urethra (the tube in the penis). Symptoms associated with ejaculatory duct obstruction are extremely variable; there may be no symptoms at all or only vague ones. Men may complain of decrease in the projectile nature of their ejaculate. Occasionally, vague discomfort is noticed in the area between the scrotum and anus.
What are the causes of ejaculatory duct obstruction?
Prior infections of the urinary tract, including prostatitis and epididymitis, are risk factors that can lead to obstruction. Any history of urologic surgery (bladder, prostate, urethra) may also be significant.
How is ejaculatory duct obstruction diagnosed?
Men with suspected ejaculatory duct blockage undergo a transrectal ultrasound. This is a procedure done in the office, in which an ultrasound probe is placed in the rectum. The probe is approximately the size of a finger and the test is comparable to a rectal exam. The ultrasound will show evidence of obstruction.
How is ejaculatory duct obstruction treated?
If obstruction is present, transurethral resection of the ejaculatory ducts (openings of the ducts) should be performed. This is done in the operating room under anesthesia. The procedure is usually performed on an outpatient basis (no overnight hospitalization) via a small telescope placed into the urethra. No skin incisions are necessary. A catheter (a tube passed through the urethra into the bladder) may be required for a day or two post-operatively. Blood may be noted in the urine post-operatively, or be present in the ejaculate (semen). This is not abnormal. The patient should refrain from sexual activity for one week. One month after procedure a semen analysis is performed.
One can expect a 50 to 80 percent chance of improvement in semen quality, and if semen quality is improved, an approximately 50 percent pregnancy rate. As in any type of surgery there is a risk of bleeding and infection. In this procedure the risk is about 1 percent. Complications of the procedure are rare. Scarring may re-block the ejaculatory ducts, necessitating a repeat resection. In extremely rare cases a condition called "retrograde" (semen travels into the bladder) or dribbling after voiding occurs.