Transrectal US-guided seminal vesicle aspiration in the diagnosis of partial ejaculatory duct obstruction

Abstract

There has been recent interest in techniques for diagnosing ejaculatory duct obstruction (EDO), especially when the partial form of the disease is suspected clinically. Currently, there is no gold standard technique for diagnosing EDO. Transrectal ultrasonography (TRUS), which is the technique used most widely, can overdiagnose EDO. As adjunctive diagnostic techniques, duct chromotubation and seminal vesiculography cannot distinguish patients with partial obstruction from those without EDO. TRUS-guided seminal vesicle aspiration can be used in conjunction with TRUS to confirm the diagnosis pre-operatively, especially in patients with seminal vesicle dilation and a prostatic midline/ejaculatory duct cyst on TRUS. In patients with findings of chronic inflammation, such as ejaculatory duct calcifications and seminal vesicle atrophy/hypoplasia on TRUS, proximal vasal obstruction or functional EDO should be excluded.