Closure of the ejaculatory duct

Location of the ejaculatory duct

The closure of the ejaculatory duct (also: central obstruction ) is a congenital or acquired, pathological condition caused by the closure of one or both injection channels (lat. Ejaculatory duct ). Thus, the normal drainage (of most of the components) of the ejaculate is not possible. The occlusion of the ejaculatory duct is a cause of the inability to conceive and / or of pelvic pain. It must not be confused with a closure of the spermatic duct .

Prevalence, Etiology, and Symptoms

An occlusion of the ejaculatory duct is the underlying cause of fertility in 1–5% of cases .

The congenital obstruction is usually caused by cysts in the Müllerian duct. The lack of chloride channels and the associated insufficient moistening of the mucus in patients with cystic fibrosis is the cause of congenital bilateral aplasia of the vas deferens (CBAVD) in about 3% of patients with azoospermia .

The acquired occlusion is caused by inflammation of the prostate ( prostatitis ), e.g. B. after infection with chlamydia and other pathogens or due to a rare tuberculosis of the prostate. In addition, cases of infertile men have been described in which limestone blocks the spray channel. In many cases an inflammation of the spray channels goes unnoticed and the cause of the blockage remains unexplained.

If both injection channels are completely closed, the affected men are unable to childbearing due to aspermia and azoospermia . Your ejaculate has a very small volume with a very liquid consistency or is completely absent (aspermia), although an orgasm with the associated involuntary contractions of the pelvic floor muscles takes place and is felt (" dry orgasm "). This is in contrast to some forms of anejaculation . When both injection channels are completely closed, any remaining volume of the ejaculate consists only of the liquid secretion of the exocrine glands of the prostate , which open "downstream" directly into the prostate part of the urethra.

Furthermore, the occlusion of the injection channels appears to be a cause of chronic or acute pelvic pain in men, especially immediately after an orgasm. In the case of proven fertility and unexplained pelvic pain, a unilateral or bilateral narrowing of the injection channel can also be the cause of the pain. A narrowing, just like a one-sided closure, is usually not expressed as azoospermia, but with only moderately reduced ejaculate volume and possibly oligozoospermia .

diagnosis

In the spermiogram , azoospermia is evident when both injection channels are blocked, i.e. no sperm are contained. Since the ejaculate, if at all yet exists only from the acid secretions of the exocrine prostate glands, but the jelly-like, fructose containing major proportion of the seminal vesicles is absent, revealing a chemical analysis of the ejaculate a low fructose concentration and a low pH . In contrast, the consequence of a closure of both vas deferens , z. B. after intended surgical sterilization , hardly noticeable without a microscope : The ejaculate still has about 80% of the previous volume (since the outflow from the seminal vesicles is not obstructed), but no longer contains any sperm. In such cases the fructose concentration is normal or even slightly increased.

To confirm the diagnosis and to rule out other causes, imaging methods are also used, namely transrectal ultrasound and magnetic resonance tomography . However, both examination methods only have a sensitivity of about 50% and are therefore only suitable for excluding an underlying cyst. An inflammatory sticking of the spray tubule can neither be reliably excluded nor proven with imaging methods without contrast media . In 50% of the cases of unclear azoospermia with low ejaculate volume, no pathological changes at all can be detected with either method.

Functional examinations have a higher sensitivity; so you can z. B. puncture the seminal vesicles via a transrectal access route with a fine needle and aspirate fluid to test whether there are sperm there. In the same session, contrast agent or dye can be injected into the seminal vesicles to test whether there is a continuous connection with the urethra , ie whether the ejaculatory duct is open. Due to the blockage of the drainage path, enlarged seminal vesicles should be observed more frequently in transrectal ultrasound , but this is also no evidence of an obstruction.

Since the occlusion of the ejaculatory duct is a relatively rare cause of the inability to conceive, the disease is unknown even to some urologists .

treatment

An occasional treatment method is resection of the front of the injection channels (TURED), a surgical method similar to the transurethral resection of the prostate , as it is used to treat benign prostatic hyperplasia . This is a relatively invasive procedure with potentially dangerous complications and has shown a naturally-induced pregnancy rate of 20% in studies. A disadvantage of this method is the destruction of the "valves" at the openings of the injection channels in the urethra, so that urine can flow back into the seminal vesicles and the semen quality deteriorates.

Another, experimental, minimally invasive procedure is the recanalization of the injection tubules with a balloon catheter . This procedure is being tested in an ongoing clinical study. While it is less invasive, less invasive, and preserves the anatomy of the injection channels, it is also not free from complications and the success rate is unknown.

Normally, the production of sperm cells ( spermatogenesis ) is not impaired in the affected men, so that the entire arsenal of reproductive medicine , in particular in vitro fertilization , can be used for treatment . However, a large part of the treatment is transferred to the (usually healthy) partner.

See also

• Retrograde ejaculation

Individual evidence

1. ↑ JP Pryor, WF Hendry: Ejaculatory duct obstruction in subfertile males: analysis of 87 patients. In: Fertility and Sterility . Oct. 1991, Vol. 56, No. 4, p. 725.
2. ↑ F. Tüttelmann, J. Gromoll, S. Kliesch: Genetics of male infertility. In: The Urologist. Jan. 2008, Vol. 47, No. 12, pp. 1561-7, doi : 10.1007 / s00120-008-1804-4 .
3. ↑ J. Philip, R. Manikandan et al .: ejaculatory duct calculus Causing secondary obstruction and infertility. In: Fertility and Sterility. Vol. 88, No. 3, Sep. 2007, p. 706, PMID 17408627 .
4. ↑ LP Lawler, O. Cosin, JP Jarow, HS Kim: Transrectal US-guided seminal vesiculography and ejaculatory duct recanalization and balloon dilation for treatment of chronic pelvic pain. In: Journal of vascular and interventional radiology. (JVIR) January 2006, Vol. 17, No. 1, pp. 169-73, PMID 16415148 .
5. ↑ G. Engin, A. Kadıoğlu et al .: Transrectal US and endrectal MR imaging in partial and complete obstruction of the seminal duct system. A comparative study. In: Acta Radiologica. May 2000, Vol. 41, No. 3, pp. 288-295, PMID 10866088 .
6. ↑ RS Purohit, DS Wu et al .: A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. In: The Journal of Urology . Jan. 2004, Vol. 171, No. 1, pp. 232-236, PMID 14665883 .
7. ^ Weill Cornell Medical College, James Buchanan Brady Foundation, Department of Urology: Ejaculatory Duct Obstruction. ( Memento of the original from February 23, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
8. ↑ Immo Schroeder-Printzen, Martin Ludwig et al .: Surgical therapy in infertile men with ejaculatory duct obstruction: technique and outcome of a standardized surgical approach. In: Human Reproduction. June 2000, Vol. 15, No. 6, pp. 1364-1368, doi : 10.1093 / humrep / 15.6.1364 ( full text online ).
9. ↑ LP Lawler, O, Cosin et al .: Transrectal US-guided seminal vesiculography and ejaculatory duct recanalization and balloon dilation for treatment of chronic pelvic pain. In: Journal of vascular and interventional radiology. (JVIR) January 2006, Vol. 17, No. 1, pp. 169-73, PMID 16415148 .
10. ↑ University Hospital Schleswig-Holstein (UK SH) / Clinic for Diagnostic Radiology: Page no longer available , search in web archives: Interventional Radiology: Balloon dilation of the ejaculatory duct (seminal canal) .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !