Simultaneous Computed Tomography and Seminal Vesiculography in a Patient With Ejaculatory Duct

• Main Authors: Sanjay Sinha, Sreenivasa R Siriguri, Rama Subba Rayudu
• Format: Article
• Language: English
• Published: Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences 2010-05-01
• Series: Urology Journal
• Online Access: http://urologyjournal.org/index.php/uj/article/view/669/461

A 32-year-old man presented with primary infertility. He had azoospermia with low volume ejaculate.Physical examination was normal. Transrectal ultrasonography (TRUS) revealed grossly dilatedseminal vesicles. No other genitourinary tract abnormality was noted. He underwent TRUS-guidedaspiration of the seminal vesicles with simultaneous instillation of contrast media and methylene bluedye into the seminal vesicles. The aspirate showed scanty sperms. Conventional radiograph (Figure 1)and simultaneous computed tomography (CT) and seminal vesiculogram images (Figure 2) were taken,which revealed the spectacular appearance of huge seminal vesicles and retrograde flow of contrastmedia into the proximally dilated system upto the epididymis. The dilated ejaculatory duct anatomycould be seen with exceptional clarity. The patient underwent transurethral resection of the ejaculatoryducts on the same day until free flow of methylene blue was noted from a wide open orifice (Figure 3).Postoperatively, he developed seminal vesiculitis which was treated with oral ciprofloxacin. He showed adelayed return of sperms into the ejaculate at 9 months.Transrectal ultrasonography alone is insufficient for the diagnosis of ejaculatory duct obstruction.(1) Onlyabout half of the patients with TRUS findings show confirmed obstruction on additional diagnosticevaluation such as examination of TRUS-guided aspirate, instillation of colored dye, and seminalvesiculography.(2) Computed tomography and seminal vesiculography may be combined easily at thetime of contrast instillation and gives excellent anatomical detail. Further studies are needed to betterelucidate the role of imaging with CT in patients with obstructive azoospermia.