A novel therapeutic method for azoospermia resulted from distal deferential obstruction
Jing, T1; Wang, PT1; Zheng, SG1; Wang, HQ1; Yu, L1; Bu, GF1; Wang, XS1
1: The Affiliated Hospital of Qingdao University, China
Objective: To evaluate the efficiency of the therapeutic method using seminal vesiculoscope with holmium laser to treat azoospermia resulted from distal deferential obstruction.
Material and Method: We recruited 6 obstructive azoospermia (OA) patients from the Andrology Clinic. All cases were diagnosed as OA caused by distal deferential obstruction via 3 consecutive semen analyses, trans-rectal B-type ultrasound and pelvic MRI. Then we performed transurethral seminal vesiculoscopy for all patients, and treated the local lesions at the distal part of deferential duct using holmium laser.
Results: Cysts with calcification at the ejaculatory ducts were found in ultrasound images in 4 of 6 patients, and the other 2 cases suffered from the unexplained stenosis of vas deferens ampulla, which resulted in the obvious dilation of proximal part. During the operation, we firstly inserted the seminal vesiculoscope into the prostatic utricle, and then decorticated the cysts located at the ejaculatory duct or resected the scars at the ampulla of deferens duct using holmium laser. Motile sperms were found in 5 of 6 patients’ semens three months after the operations. Negative sperm in semen happened in only one patient with severe long stenosis of the vas deferens ampulla.
Conclusions: Trans-rectal B-type ultrasound is more effective than pelvic MRI in diagnosing the lesions at the distal part of vas deferens. The therapeutic method using seminal vesiculoscope with holmium laser is a reasonable choice for OA patients resulted from distal deferential obstruction. However, the validity of this method in treating severe deferential stenosis still needs further verification.
Fig. Representative seminal vesiculoscopy images showing the surgical findings in one case of ejaculatory duct cyst (A, B, C) and the other case of deferential ampulla stenosis (D, E, F). (A) A cyst with calcification was found at the wall of right ejaculatory duct (arrow). (B) The roof of the cyst was resected using holmium laser (arrow). (C) The lumen of right ejaculatory duct appeared after the operation (arrow). (D) The lumen of left deferential ampulla was filled with scars (arrow). (E) The scars were resected using holmium laser (arrow). (F) A tunnel passing through the scars of left deferential ampulla was built up after the operation (arrow).
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