Ejaculatory Duct Obstruction: An Overview

Introduction

Ejaculatory duct obstruction is sperm duct obstruction, a condition that mainly affects male reproductive health. The condition often leads to infertility in males; however, the condition is treatable. Ejaculatory ducts are vital in carrying semen from the seminal vesicles (tubular accessory glands) into the urethra. Therefore, ejaculatory duct obstruction blocks this passage and, thus, leads to various health conditions, such as sexual dysfunction and infertility.

The condition can be of two types - acquired or congenital. Acquired EDO usually occurs in later life due to some infection, inflammation, or some medical condition. In contrast, congenital EDO has been present since birth and occurs due to some developmental issues or anatomical abnormalities.

The article discusses ejaculatory duct obstruction, its types, causes, symptoms, diagnosis, and treatment.

What Is an Ejaculatory Duct?

Ejaculatory ducts are present in the male reproductive system. These are paired structures or two tubes, approximately two centimeters in length, present beside the prostate gland, with a urethra present on either side.

The ejaculatory duct is mainly divided into three parts:

• Proximal Ejaculatory Duct: It is the uppermost part of the duct and is connected to seminal vesicles directly. It is approximately 1.7 meters in diameter and, thus, is the thickest part of the ejaculatory duct. It mainly comprises three layers, the inner mucus layer, the outer muscular layer, and the inner collagenous protein layer.

• Middle Ejaculatory Duct: This part of the ejaculatory duct connects the proximal part with the topmost part of the distal part of the ejaculatory duct. It is about 0.6 millimeters in length, and the part of it present in the prostrate measures around 15 millimeters.

• Distal Ejaculatory Duct: This part of the ejaculatory duct starts from the prostate, connects the middle part of the duct, and joins the urethra, bypassing over the prostatic utricle. The distal part measures around 0.3 millimeters.

How Does the Ejaculatory Duct Work?

The ejaculatory duct helps in the movement of sperm (semen) from the vas deferens to the urethra. The process occurs inside the testis, which produces sperm. The smooth movement of sperm is facilitated by fructose, a nourishing fluid in the seminal vesicles. Furthermore, the sperm gets alkaline fluid inside the ejaculatory duct, which ensures the longevity of the semen and thus helps in reproduction. Finally, the sperm gets passed into the urethra for release.

What Are the Causes of Ejaculatory Duct Obstruction?

Causes of ejaculatory duct obstruction include:

• Calculi or stones.

• Cysts.

• Inflammatory conditions include prostatitis and epididymitis (epididymis inflammation, a cord that transports sperm to the back of the testis).

• Urinary tract infection.

• Pelvic trauma or injury leading to tissue scarring followed by obstruction of the ejaculatory duct.

• Congenital structural abnormalities include Artesia (absence) or atrophic (collapsed) ducts.

What Are the Various Types of Ejaculatory Duct Obstruction?

Ejaculatory duct obstruction is of the following types:

• Classic or Complete EDO: Blockage of both the ducts.

• Functional EDO: This type is quite similar to complete ejaculatory duct blockage, but there is no physical blockage in functional EDO.

• Partial or Incomplete EDO: Blockage can be complete in one duct, or incomplete in both ducts.

What Are the Clinical Manifestations of Ejaculatory Duct Obstruction?

The signs and symptoms of ejaculatory duct obstruction include:

• Pain during or after sexual intercourse.

• Hematuria or blood in urine.

• Pain in the prostate.

• Low sperm count or low sperm output.

• Hematospermia or blood in semen.

• Infertility.

• Less ejaculation volume, which is less than 1.5 million.

How Is Ejaculatory Duct Obstruction Diagnosed?

The condition is diagnosed in the following ways:

• Semen Analysis: This rules out sperm count, morphology, and motility.

• Cystoscopy: In this method, a thin tube with an attached camera is inserted in the ejaculatory duct through the urethra to examine the ejaculatory duct.

• Transrectal Ultrasound: This diagnostic method is used to visualize the abnormalities and blockage in the ejaculatory duct.

• Vasogram: In this procedure, a dye is injected into the vasa deferens, which helps to locate the exact location of the blockage in the ejaculatory duct.

• Urodynamic Studies: This helps to evaluate the flow and pressure inside the urinary tract, thus helping to identify the problem or cause of obstruction in the duct.

What Is the Treatment for Ejaculatory Duct Obstruction?

Ejaculatory duct obstruction is treated based on the severity and the underlying medical cause of the condition.

Treatment includes:

• Anti-inflammatory drugs or antibiotics are prescribed by the doctor in case of inflammation or infection.

• A balloon dilation procedure widens the ejaculatory duct passage by inflating the balloon.

• The cysts or obstructions are removed from the ejaculatory duct with the help of a surgical procedure called transurethral resection of the ejaculatory duct or TURED.

• Seminal vesiculoscopy, a minimally invasive procedure, is also used to treat EDO. This involves the insertion of a small camera into the prostate and surgical removal of the blocked duct.

• In some cases of infertility caused by ejaculatory duct obstruction, doctors advise assisted reproductive techniques or ART, such as IVF (In-vitro fertilization) to achieve pregnancy.

What Are the Complications Associated with the Treatment of EDO?

Complications of TURED:

• One may develop epididymitis.

• A person may emit watery fluid during an orgasm.

• Recurrence of blockage.

• Urinary incontinence.

• Injury to rectum.

Complications of Seminal Vesiculoscopy:

• Feeling of the lesser volume of semen ejaculation.

• Feeling of reduced or altered sexual performance or function.

When Should One See a Doctor?

One should see a doctor in the following cases:

• Pain (new or increased).

• Bleeding (new or increased).

• Shaking or chills.

• Allergic reactions are caused by certain medications.

• High-grade fever (102 degrees Fahrenheit).

• Pain or swelling around the incision area in the legs.

What Are the Other Causes of Infertility in Men?

• Hernia repair.

• Medical history of sexually transmitted diseases, prostatitis (inflammation of the prostate), and genital infections.

• Heavy alcohol consumers.

• Marijuana or cigarette smokers.

• Undescended testicles.

• Congenital or genital issues or problems.

• Prescription drugs, such as opioid medications.

• Mumps after puberty.

• Exposure to toxic substances, such as radioactive agents, chemicals, or radiation.

Conclusion

Ejaculatory duct obstruction is a rare condition arising in males which may affect their reproductive health. However, advanced diagnostic techniques have made it possible to identify the condition in males and provide significant treatment. The treatment is mostly surgical, and the condition is manageable in most cases. Therefore, one must consult the doctor timely if any symptoms of ejaculatory duct obstruction are encountered, and one must not lose hope.