Comparison of transrectal ultrasonography and transrectal ultrasonography-guided seminal vesicle aspiration in the diagnosis of the ejaculatory duct obstruction

Objective: To compare transrectal ultrasonography (TRUS) and TRUS-guided seminal vesicle aspiration in the diagnosis of ejaculatory duct obstruction (EDO). Design: A retrospective case-controlled study comparing the findings of TRUS and TRUS-guided seminal vesicle (SV) aspiration. Setting: Clinics of Urology and Radiology. Patient(s): Seventy patients with suspected EDO (complete in 10, partial in 60 patients) on clinical evaluation. Intervention(s): Each SV was punctured transrectally using a 20-gauge Chiba needle within 2 hours after ejaculation. Main outcome measure(s): In SV aspirates, greater than three sperm per high-power microscopic field was considered a positive result for EDO. Result(s): Fifty-five (78.6%) patients had evidence of EDO on diagnostic TRUS. However, obstruction on TRUS was confirmed in 49.1% (27 of 55) of the patients with SV aspiration. Higher sperm positivity rates were achieved in patients with SV dilation (11 of 13, 84.6%) and prostatic midline/ED cyst (12 of 16, 75.0%). Stepwise logistic regression analysis revealed that the incidence of SV dilation was significantly higher, whereas that of chronic inflammatory findings in the prostate was significantly lower in the positive SV aspirate group. Conclusion(s): TRUS alone is not a reliable tool for the diagnosis of EDO. For this reason, SV aspiration should be used as an adjunctive technique in patients with SV dilation or a prostatic midline/ED cyst to confirm the diagnosis before surgery. (Fertil Steril (R) 2009;92:964-70. (C)2009 by American Society for Reproductive Medicine.)