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  • Print publication year: 2008
  • Online publication date: August 2010

17 - Transrectal Ultrasonography in Male Infertility

from PART II - INFERTILITY EVALUATION AND TREATMENT

Summary

Transrectal ultrasound (TRUS) evaluates the distal components of the ejaculatory duct system including the ampullae of the vas deferens, the seminal vesicles, ejaculatory ducts, and the prostate. Patients with complete distal ejaculatory obstruction and partial distal obstruction are ideal candidates for TRUS evaluation. The examination can be performed with the patient in the lithotomy, knee-chest, or lateral decubitus position. Lateral decubitus position is the preferred position as this provides easy access for the operator and less discomfort for the patient. On TRUS examination, the seminal vesicles appear as hypoechoic areas with fine septations. Anteroposterior diameter up to 15 mm is considered normal. Importantly, TRUS can reveal the anatomical relationship between ejaculatory channels and calcifications. It can also detect proximal dilatation of the ejaculatory tract, which indirectly implies the presence of a distal obstruction. TRUS can also be used for therapeutic aspiration and reduction in the size of obstructive cysts.
REFERENCES
Zahalsky, M. and Nagler, H. Ultrasound and infertility: diagnostic and therapeutic uses. Curr Urol Rep (2001), 2, 437–42.
Cerruto, M.A., Novella, G., Antoniolli, S.Z. and Zattoni, F. Use of transperineal fine needle aspiration of seminal vesicles to retrieve sperm in a man with obstructive azoospermia. Fertil Steril (2006), 86, 1764.e7–9.
Irvin, D.S. Epidemiology and etiology of male infertility. Hum Reprod (1998), 13, Suppl. 1:33–44.
Dohle, G.R., Colpi, G.M., Hargreave, T.B., Papp, G.K., Jungwirth, A. and Weidner, W. The EAU Working Group on Male Infertility. EAU guidelines on male infertility. Eur Urol (2005), 48, 703–11.
Goluboff, E.T., Stifelman, M.D. and Fisch, H. Ejaculatory duct obstruction in the infertile male. Urology (1995), 45, 925–31.
Colpi, G.M., Casella, F., Zanollo, A., Ballerini, G., Balerna, M., Campana, A. and Lange, A. Functional voiding disturbances of the ampullo-vesicular seminal tract: a cause of male infertility. Acta Eur Fertil (1987), 18, 165–79.
Pierik, F.H., Vreeburg, J.T., Stijnen, T., Jong, F.H. and Weber, R.F. Serum inhibin B as a marker of spermatogenesis. J Clin Endocrinol Metab (1998), 83, 3110–4.
Veltri, R. and Rodriquez, R. The molecular biology, endocrinology, and physiology of the prostate and seminal vesicles. In Wein: Campbell-Walsh Urology: Ninth Edition, Chapter 85: ed. Wein, A.J. et al. (Philadelphia, PA: Saunders Company, 2007).
Kato, H., Hayama, M., Furuya, S., Kobayashi, S., Islam, A.M. and Nishizawa, O. Anatomical and histological studies of so-called Mullerian duct cyst. Int J Urol (2005), 12, 465–8.
Weintraub, M.P., Mouy, E. and Hellstrom, W.J.G. Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction. J Urol (1993), 150, 1150–4.
Purohit, R.S., Wu, D.S., Shinohara, K. and Turek, P.J. A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol (2004), 171, 232–5.
Schlegel, P.N., Shin, D. and Goldstein, M. Urogenital anomalies in men with congenital absence of the vas deferens. J Urol (1996), 155, 1644–8.
Chillon, M., Casals, T., Mercier, B., et al. Mutations in the cystic fibrosis gene in patients with congenital absence of the vas deferens. N Engl J Med (1995), 332, 1475–80.
Shabsigh, R., Lerner, S., Fishman, I.J. and Kadmon, D. The role of transrectal ultrasonography in the diagnosis and management of prostatic and seminal vesicle cysts. J Urol (1989), 141, 1206–9.
Elder, J.S. and Mostwin, J.L. Cyst of the ejaculatory duct/urogenital sinus. J Urol (1984), 132, 768–771.
Kuligowska, E. and Fenlon, H.M. Transrectal US in male infertility: spectrum of findings and role in patient care. Radiology (1998), 207, 173–81.
Silber, S.J. Ejaculatory duct obstruction. J Urol (1980), 124, 294–7.
Patterson, L. and Jarow, J.P. Transrectal ultrasonography in the evaluation of the infertile man: a report of three cases. J Urol (1990), 144, 1469–71.
Nguyen, H.T., Etzell, J. and Turek, P.J. Normal human ejaculatory duct anatomy: a study of cadaveric and surgical specimens. J Urol (1996), 155, 1639–42.
Orhan, I., Onur, R., Cayan, S., Koksal, I.T. and Kadioglu, A. Seminal vesicle sperm aspiration in the diagnosis of ejaculatory duct obstruction. BJU Int (1999), 84, 1050–3.
Fisch, H., Kang, Y.M., Johnson, C.W. and Goluboff, E.T. Ejaculatory duct obstruction. Curr Opin Urol (2002), 12, 509–15.
Schroeder-Printzen, I., Ludwig, M., Kohn, F. and Weidner, W. Surgical therapy in infertile men with ejaculatory duct obstruction: technique and outcome of a standardized surgical approach. Hum Reprod (2000), 15, 1364–8.
Halpern, E.J. and Hirsch, I.H. Sonographically guided transurethral laser incision of a Mullerian duct cyst for treatment of ejaculatory duct obstruction. Am J Roentgenol (2000), 175, 777–8.
Apaydin, E., Killi, R.M., Turna, B., Semerci, B. and Nazli, O. Transrectal ultrasonography-guided echo-enhanced seminal vesiculography in combination with transurethral resection of the ejaculatory ducts. BJU Int (2004), 93, 1110–2.
Boehlem, D. and Schmid, H.P. Novel use of fine needle aspiration of seminal vesicles for sperm retrieval in infertile men. Urology (2005), 66, 880.
Hellstrom, W.J.G. and Gurkan, L. Ultrasonography in male infertility. In Rizk, B (Ed.) Ultrasonography in Reproductive Medicine and Infertility. Cambridge University Press, 2008, Chapter 22, pp. 268–72.