A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction

Purpose: Various diagnostic tests are available to evaluate patients with ejaculatory duct obstruction (EDO). However, the most accurate diagnostic technique, defined as the one that best predicts a successful outcome after ejaculatory duct resection, is unclear. We prospectively performed transrectal ultrasound (TRUS) and 3 other tests in men with EDO and determined their relative value in this diagnosis. Materials and Methods: Patients with suspected EDO on clinical evaluation that included TRUS proceeded to further intraoperative evaluation with duct chromotubation, seminal vesicle aspiration and seminal vesiculography. A comparative analysis of findings from each technique was performed and the success of subsequent transurethral resection procedures was assessed. Results: All 25 patients had evidence of EDO on diagnostic TRUS, a finding that merited further evaluation with other modalities. However, TRUS findings correlated poorly with those of the other diagnostic tests. Obstruction on TRUS was confirmed in only 52%, 48% and 36% of vesiculography, seminal vesicle aspiration and duct chromotubation studies, respectively. A better correlation was observed between the dynamic tests of duct chromotubation and seminal vesiculography. Based on all diagnostic tests only 12 patients (48%) proceeded to duct resection, of whom 10 (83%) showed significant improvement in semen analysis parameters or clinical symptoms after the procedure. Conclusions: A comparative analysis of 4 diagnostic techniques suggests that TRUS alone has poor specificity for EDO evaluation. Incorporating dynamic tests into the algorithm of EDO diagnosis may decrease unnecessary duct resection procedures and improve the success of the resection procedures that are indicated.