Fisch Harry, Lambert Sarah M, Goluboff Erik T
Department of Urology, Squier Urologic Clinic Male Reproductive Center, College of Physicians and Surgeons, Columbia University, 944 Park Avenue, New York, NY, USA.
World J Urol. 2006 Dec;24(6):604-10. doi: 10.1007/s00345-006-0129-4.
Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.
与不育相关的射精管远端异常已有充分记录。虽然没有与射精管梗阻相关的特异性发现，但有几个临床发现具有高度提示性。对于精液量少或无精子症、第二性征正常、睾丸及激素水平正常、经直肠超声检查显示精囊扩张、中线囊肿或钙化的不育男性，提示射精管梗阻的诊断。可能同时存在其他不育原因，需要进行评估和治疗。经尿道射精管切除术（TURED）已使精液参数显著改善，并已实现妊娠。为获得最佳效果，需要进行恰当的患者选择和手术经验。如果存在睾丸功能障碍，成功的机会极小。TURED术后需要延长随访期以检查该手术的长期效果。对射精管解剖和病理的更好理解将继续完善针对该疾病的诊断和治疗程序。
