Ejaculatory Duct Obstruction (Male Infertility ) - Diagnosis скачать в хорошем качестве

Ejaculatory Duct Obstruction (Male Infertility ) - Diagnosis

The diagnosis of Ejaculatory duct obstruction leading to male infertility is confirmed by a combination of findings on semen analysis that is, the ejaculate volume less than 1 mL and a pH less than 7 that contains no sperm or fructose in the presence of palpable vas deferens A Trans Rectal Ultrasound may demonstrate dilated seminal vesicles more than 1.5 cm in width or dilated ejaculatory ducts greater than 2.3 mm in association with a cyst, calcification, or stones along the duct. Recently, high-resolution TRUS Ultrasound has virtually replaced the more invasive vasography for the diagnosis. MRI with endorectal coil is recommended in suspicious cases without TRUS findings as it is excellent for the detection of small cysts. To complete the evaluation for infertility, it is important that the serum follicle-stimulating hormone FSH and testosterone levels be normal. Testicular volume should also be normal. A testis biopsy confirming ongoing sperm production may be helpful but is not always necessary. Not all patients with ejaculatory duct obstruction have dilated seminal vesicles, and not all patients with dilated seminal vesicles have ejaculatory duct obstruction. This has led to refinements in diagnostic techniques. Researchers have found that seminal vesicle sperm aspiration with TRUS more accurately defined affected patients. Importantly, the duration of sexual abstinence prior to aspiration can influence the findings. Seminal vesicle aspiration should be performed with less than 24 hours of sexual abstinence.