Transurethral Resection of the Ejaculatory Duct Obstructed

Transurethral resection of ejaculatory duct or TURED is an effective surgical treatment for unblocking the ejaculatory duct obstruction or EDO. This procedure involves removing the obstruction in the duct to let the semen and the sperm to mix and form a healthy and fertile ejaculate. The TURED surgery has improved their sperm count and spontaneous conception rate in about 30 % of men with EDO.

Who Needs TURED?

TURED is performed in men with the following conditions:

• No or few sperms found in the ejaculate
• A poor volume of semen discharged or ejaculate
• Midline cyst within the ejaculatory duct

Transrectal ultrasonography or TRUS is used to diagnose EDO. It helps in locating the blocked site and also assesses the motility of the sperm. If accurately diagnosed, the EDO can be easily corrected using with minor treatments.

What is EDO?

Ejaculatory duct obstruction is a condition in which the there is an obstruction in one or both the ejaculatory duct that results in low semen volume and very few sperm counts.

According to the area of blockage, EDO is classified into three categories:

• Classic or complete EDO
• Partial EDO and Functional EDO

This condition is caused by either acquired disorders or congenital blockage. Symptoms of EDO include Hematospermia, painful ejaculation or infertility.

How is TURED Performed?

The medications used to treat EDO can cause certain side effects like erectile dysfunction. So, transurethral resection of ejaculatory duct is considered as a more definitive treatment of EDO.

This is an hour-long procedure and is performed under regional or general anesthesia. To visualize the interiors of the duct an instrument called cystoscope is inserted. With the help of cystoscope, the entry point of the duct is identified and a cut is made to reveal the duct. After the completion of resection, the patency of the duct is confirmed by massaging the prostate which makes the dye flow out of the ejaculatory ducts.

The surgeon has to carefully perform the ejaculatory duct resection without damaging the neck of the bladder on the top, and the rectum at the back and the sphincter at the bottom. Post operation, a small Foley bladder catheter is placed for 24 hours. To check the semen quality, the patient will be asked to come for semen analysis 2-weeks post resection and at regular intervals after that. The patient will also be asked to wait for 5 days before resuming sexual intercourse again.

Is TURED Effective?

Men after TURED have shown great improvements in their semen quality and were also successful in impregnating their partner. Hematospermia and obstruction due to cysts have been effectively treated after TURED surgery. There are certain complications involved with TURED surgery, such as blood in urine, watery ejaculate, epididymitis, and in rare cases rectal perforation or incontinence.