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Men with cancer rendered infertile by surgery, chemotherapy, radiation and hormone therapy that are needed to control or cure their disease are increasingly being offered the chance to preserve their reproductive potential through artificial reproductive technologies. Cryopreservation of sperm and testicular tissue have increasingly helped boys and men preserve their fertility. There is a growing subspecialty within reproductive medicine aimed at fertility preservation in this population. Furthermore, strategies are being developed that may in the future revolutionize the approach to such patients. Written by international authorities in the field of fertility preservation, this comprehensive book is aimed at clinicians dealing with male cancer patients, in particular, urologists, andrologists, oncologists, pediatricians and nursing staff as well as clinicians in reproductive endocrinology. The text reviews the impact of cancers and their treatment on male fertility, the available fertility preservation strategies and post-treatment management.
This chapter offers a discussion of basic normal ejaculatory duct embryology, anatomy, and physiology to lay a foundation for an understanding of the clinical findings and treatment of obstruction. In the male the mesonephric duct continues to develop into the epididymis, vas deferens, seminal vesicle, and ejaculatory duct. The remnant Müllerian structures in the male are the prostatic utricle and appendix testis, and in some men remnant Müllerian duct structures can be found in the midline of the prostate as Müllerian duct cysts. The ultrasonographic diagnosis of ejaculatory duct obstruction is based upon the finding of dilation of the seminal vesicles and abnormalities in the region of the ejaculatory ducts. Stricturing of the resected ejaculatory ducts may represent the most significant complication in regard to fertility, and may occur immediately or in a delayed fashion.