Normal Human Ejaculatory Duct Anatomy: A Study of Cadaveric and Surgical Specimens

Purpose

We examined the anatomy of the ejaculatory ducts in normal men and correlated findings with theories of ejaculatory duct obstruction.

Materials and Methods

Gross and microscopic anatomical studies were performed on cadaveric and operative specimens derived from radical prostatectomy.

Results

Histologically, the ejaculatory ducts are a continuation of the seminal vesicles. However, the thick muscle wall of the seminal vesicle is not present within the ejaculatory duct. Normal ejaculatory duct luminal and wall dimensions are remarkably uniform among men. A luminal diameter of greater than 2.3 mm. defines a dilated system statistically.

Conclusions

The largely collagenous ejaculatory ducts may serve as simple semen conduits instead of muscular tubes with spasmodic, sphincteric or peristaltic properties. The anatomical findings presented suggest several possible mechanisms for the prevention of urinary reflux into the ejaculatory ducts.     

Seminal Vesicle Aspiration of Fertile Men

Purpose

Whether sperm normally reside in the seminal vesicles of fertile men without ejaculatory duct obstruction, and the effect of duration of sexual abstinence on results of seminal vesicle aspiration were determined.

Materials and Methods

Bilateral seminal vesicle aspiration was performed on 12 fertile volunteers under transrectal ultrasound guidance with randomization according to 0 and 5 days of abstinence. Seminal vesicle were examined microscopically for number and motility of sperm. A positive aspirate was defined as greater than 3 sperm per high power microscopic field.

Results

Duration of abstinence had a significant effect on outcome of seminal vesicle aspiration in fertile volunteers. No volunteer with 0 days of abstinence had a positive aspirate from either seminal vesicle, whereas a third of those with 5 days of abstinence had at least 1 positive seminal vesicle aspirate.

Conclusions

Significant numbers of sperm are not normally found in the seminal vesicles of fertile men immediately after ejaculation. Diagnostic seminal vesicle aspiration should be performed after 0 days of abstinence. Longer periods of sexual abstinence may be used in patients undergoing seminal vesicle harvesting of sperm for assisted reproduction.     

OUTCOME OF MICROSURGICAL RECONSTRUCTION IN MEN WITH SUSPECTED EPIDIDYMAL OBSTRUCTION

Purpose

Approximately 3 to 6% of all men presenting with infertility (excluding those with a history of vasectomy) are suspected of having epididymal obstruction. However, other anatomical abnormalities within the male reproductive tract are often encountered. In this study we attempted to define the range and frequencies of anatomical abnormalities in the reproductive tract and the outcome of surgical reconstruction in men with suspected epididymal obstruction and no history of vasectomy.

Materials and Methods

Between July 1992 and July 1996, 80 azoospermic men with suspected epididymal obstruction underwent scrotal exploration. The anatomical findings and outcomes of reconstructive surgery were reviewed.

Results

Of a possible 160 reproductive tract units (2 per patient) we thoroughly examined 147 with suspected epididymal obstruction. Epididymal obstruction was found in 52.7% of the cases with other anatomical abnormalities accounting for the remaining 47.3%. Of the patients 49 (61%) had sperm identified in the epididymis on at least 1 side and underwent vasoepididymostomy, and 3 (4%) had sperm unilaterally in the proximal vas but had ipsilateral distal vasal obstruction. These 3 men underwent crossed vasovasostomy. We were more likely able to perform reconstruction in men whose obstruction was due to an infectious etiology (13 of 14, 93%) compared to either a surgical (5 of 7, 71%) or idiopathic (34 of 59, 58%) etiology. In 28 patients (35%) no sperm was identified in the epididymis or they had no other abnormalities that precluded successful reconstruction on either side. Of those patients who underwent vasoepididymostomy for epididymal obstruction 61% had sperm in the ejaculate postoperatively.

Conclusions

In nearly half the men with suspected epididymal obstruction other reproductive tract abnormalities were detected, most of which precluded successful vasoepididymostomy. Other reproductive tract abnormalities are much less likely to be found, and the outcomes of reconstruction are better if the cause of the obstruction is infectious compared to surgical or idiopathic.     

TRANSURETHRAL RESECTION OF PARTIALLY OBSTRUCTED EJACULATORY DUCTS: SEMINAL PARAMETERS AND PREGNANCY OUTCOMES ACCORDING TO THE ETIOLOGY OF OBSTRUCTION

Purpose

We determine how transurethral resection of the ejaculatory ducts performed for infertility affects seminal parameters and pregnancy outcomes in patients with partial ejaculatory duct obstruction due to a congenital or acquired etiological factor.

Materials and Methods

Based on history and physical examination, hormonal profiles, semen analyses, transrectal ultrasonography and vasography findings partial ejaculatory duct obstruction was diagnosed in 14 men a mean of 30 years old who presented for infertility evaluation. Patients were grouped according to congenital or acquired cause of obstruction. Transurethral resection of the ejaculatory ducts was performed using the standard resectoscope loop technique. Clinical outcome was assessed by postoperative analyses of seminal parameters and pregnancy reports.

Results

Transurethral resection of the ejaculatory ducts significantly improved semen quality (ejaculate volume and percentage of sperm motility) in all patients in the congenital group, while all but 1 (83%) had an improved sperm count. Pregnancy was achieved via sexual intercourse by 66% of the patients an average of 5.7 months postoperatively. Of the acquired etiological factor group 37.5% had improved semen quality after transurethral resection of ejaculatory duct and 12.5% achieved pregnancy via sexual intercourse. Postoperative complications occurred at a similar rate in each group (33%). However, complications in the congenital etiology group were minor, while 25% of the men in the acquired group had significant impairment of seminal parameters after transurethral resection of the ejaculatory ducts.

Conclusions

Semen quality improvement and pregnancy outcome after transurethral resection of the ejaculatory ducts for partial ejaculatory duct obstruction differ significantly according to the main etiological cause of obstruction. An equivocal diagnosis of partial obstruction and technical problems during transurethral resection of the ejaculatory ducts may contribute to failure. However, in some cases the reason for failure remains unclear.     

Semen Parameters Before and After Transurethral Surgery for Ejaculatory Duct Obstruction

Purpose

We examined how transurethral resection of the ejaculatory ducts, performed for infertility, affects semen quality in patients with azoospermia and oligo-asthenospermia.

Materials and Methods

A retrospective review was done of 46 cases of transurethral resection of the ejaculatory ducts for ejaculatory duct obstruction, confirmed by transrectal ultrasound. Clinical course and semen quality were assessed by semen parameter indications.

Results

In 65 percent of the patients transurethral resection of the ejaculatory ducts improved semen quality (greater than a 50 percent increase in total motile sperm count) and 20 percent initiated a pregnancy an average of 6.1 months postoperatively. Statistically significant increases in total motile sperm count were achieved in men with azoospermia and those treated for oligo-asthenospermic indications; the improvement also was shown to be sustainable. Complications occurred in 20 percent of the men.

Conclusions

Significant and durable semen quality improvement can be achieved after transurethral resection of the ejaculatory ducts for all surgical indications. In most unsuccessful cases the reason for failure is unclear.     

Magnetic Resonance Imaging in Hemospermia

Purpose

We evaluated the prostate and seminal tract with magnetic resonance imaging (MRI) in patients with hemospermia.

Materials and Methods

To evaluate the prostate and seminal tract in 17 patients 20 to 59 years old (mean age 44) with hemospermia we performed transrectal ultrasound and MRI using an endorectal surface coil with a 1.5 tesla unit. Mean duration of hemospermia was 32 months (1 week to 16 years).

Results

Abnormalities were noted on transrectal ultrasound in 15 of the 17 patients (88%) and on MRI in all. Of the 12 cases of hemorrhage 10 involved the seminal vesicle and 2 involved the ejaculatory duct. There were 12 cystic lesions, including 7 in the mullerian and 5 in the ejaculatory ducts. Of 19 cases calculi were detected in the prostate in 5, seminal vesicle in 8, and ejaculatory and mullerian duct cysts in 4 and 2, respectively. There was 1 case of prostatic atrophy and 1 wolffian duct anomaly associated with an ejaculatory duct cyst, ectopic ureterocele and absence of the left kidney.

Conclusions

MRI with an endorectal surface coil is a powerful modality for evaluating the seminal tracts of patients with hemospermia. It can be performed clinically when transrectal ultrasonography is not satisfactory.     

Inflammatory-associated obstructions of the male reproductive tract

A history of urogenital inflammation occurs in 5-12% of men attending infertility clinics. Usually, infection has a detrimental effect on sperm quality by reducing concentration and motility, and possibly affecting the number of morphological normal spermatozoa. In addition, infection may be the source of auto-antibodies against spermatozoa, found in about 8% of the infertile male population. In contrast to the situation in women, there is no clear evidence that male accessory gland infections can result in epididymal blockage or vassal obstruction, with the exception of genital tuberculosis. Although Chlamydia trachomatis is a well-documented source of chronic prostatitis, the infection does not seem to cause obstruction of the reproductive tract, as it does in women. If male urogenital infection causes obstruction it is most likely located at the level of the ejaculatory ducts. Chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts, resulting in low seminal volume with low fructose and alpha-glucosidase. Many of these men present with severe oligozoospermia or azoospermia, normal size testis and normal gonadotrophins. We performed an excisional testicular biopsy in all men presenting with <1 million spermatozoa per millilitre and found that 39 of 78 (50%) had a normal spermatogenesis. A history of male accessory genital infection was found in 12% of the men and 10% had abnormalities found on transrectal ultrasound of the prostate (like oedema, dilatation of the seminal vesicles and ejaculatory ducts) intraprostatic calcifications and dilatation of the periprostatic venous plexus. Ejaculatory duct obstruction is a common cause of male infertility and infections are present in at least 22-50% of these men. Transurethral resection of the ejaculatory ducts may result in a significant improvement of the sperm quality and in spontaneous pregnancies in up to 25% of the couples. In case of failure sperm aspiration from the epididymis and intracytoplasmic sperm injection is the treatment of choice.     

Vasoepididymostomy for Vasectomy Reversal: A Critical Assessment in the Era of Intracytoplasmic Sperm Injection

Purpose

We compared vasoepididymostomy to microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection for treatment of epididymal obstruction secondary to vasectomy.

Materials and Methods

Results in patients who underwent vasoepididymostomy for vasectomy reversal at our institution were compared to those reported previously for microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection performed for obstructive azoospermia. The pregnancy rates, delivery rates, complications, cost per procedure and cost per delivery were compared. A cost per newborn analysis was performed using pregnancy and delivery rates, and reported cost estimates for the complications of assisted reproductive techniques.

Results

A total of 55 men underwent 58 vasoepididymostomies in an attempt to restore fertility after vasectomy. Median followup was 19 months (range 0 to 115). Median obstructive interval was 12 years. There were no major complications. The patency rate after 6 months was 85%. Of the couples 20 achieved 24 pregnancies and 16 had 17 live births. The pregnancy rate at 1 year was 44%. There were 4 miscarriages and there are 3 ongoing pregnancies. The live delivery rate was 36%. Assuming a 29% delivery rate for microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection, the cost per newborn was $51,024, compared to $31,099 for vasoepididymostomy.

Conclusions

Vasoepididymostomy is more successful and more cost-effective than microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection for vasectomy reversal. It does not expose the women to complications in the treatment of a male problem and it is indicated for treatment of epididymal obstruction secondary to vasectomy. Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection should be reserved for cases not amenable to surgical reconstruction.     

评价经直肠彩色多普勒超声在男性不育症精囊和射精管病变诊断中的价值

目的探讨经直肠超声在男性不育症患者精囊和射精管病变诊断中的价值.方法应用经直肠彩色多普勒超声技术对50例男性不育症患者进行精囊和射精管检查.结果男性不育症患者经直肠超声表现呈现多样性特点,其中包括精囊先天性缺如和发育不良、慢性精囊炎如精囊肿大或精囊壁增厚伴钙化,射精管梗阻性病变如射精管扩张以及射精管囊肿,射精管壁钙化等.部分病例未发现明显精囊和射精管病变.结论经直肠彩色多普勒超声可用于射精管梗阻性病变和精囊先天性改变的诊断.对于精囊炎症性表现具有一定诊断意义,它是男性不育症患者精囊和射精管病变诊断的理想手段.     

Novel methods for the diagnosis and treatment of ejaculatory duct obstruction

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVES

? To investigate a new method of vas deferens radiography for ejaculatory duct obstruction (EDO). ? To evaluate the effect of a procedure involving dilation of the ejaculatory duct by F9 seminal vesicoscopy.

PATIENTS AND METHODS

? Twenty‐two patients with EDO were diagnosed using semen analysis, semen fructose measurement, transrectal ultrasonography (TRUS) and vas deferens radiography. ? Of these, 18 patients were successfully treated by dilation of ejaculatory duct using F9 seminal vesicoscopy and four patients, whose treatment was unsuccessful, were treated by transurethral resection of the ejaculatory ducts (TURED). ? All patients were followed up for at least 3 months after treatment.

RESULTS

? Semen analyses in all 22 patients showed oligoasthenozoospermia or azoospermia, low semen volume (0–1.9 mL), low pH level (5.6–7.0) and absent or low semen fructose. TRUS and radiography showed pure dilated seminal vesicles on both sides in three patients, partial dilated seminal vesicles in one patient, dilation of both the ejaculatory duct and seminal vesicles in ten patients, dilated seminal vesicles and a prostatic cyst in four patients, and dilated ejaculatory duct or cystic lesions without dilated seminal vesicles in the remaining four patients. ? At >3‐month follow‐up after dilation or TURED, the semen characteristics of 18 patients were improved and sperm were present in the semen in 13 cases. Normal semen analyses were found in 7 patients and 6 patients had conceived. ? Voiding urethral radiography showed that no patients who had undergone dilation by seminal vesicoscopy had urine reflux into the ejaculatory duct. Only one patient showed urine reflux into the seminal vesicle after TURED. ? All patients felt that their symptoms had improved after treatment.

CONCLUSIONS

? The approach to vas deferens radiography using vas deferens aspiration has proved to be an effective and safe method for EDO diagnosis. ? The procedure involving the dilation of the ejaculatory duct using F9 seminal vesicoscopy is equally effective but has fewer postoperative complications than TURED.     

梗阻性无精子症的外科治疗(附56例报告)

目的:探讨梗阻性无精子症的诊断和外科治疗方法。方法:分析2004年10月至2008年11月间收治的56例梗阻性无精子症患者的临床资料,其中43例为射精管梗阻性无精子症,13例疑为附睾水平梗阻性无精子症。常规精液分析、精浆果糖和中性α葡糖苷酶测定以及经直肠超声检查(TRUS)对其进行诊断,必要时行输精管造影检查。43例为射精管梗阻性无精子症使用经尿道射精管切开术(TURED)治疗,13例疑为附睾水平梗阻性无精子症行阴囊探查术,对其中11例确定为附睾水平梗阻行双侧或单侧附睾输精管端侧吻合术,术后随访其疗效。结果:所有患者均完成手术,术后随访3～51个月。43例射精管梗阻性无精子症TURED术后,36例(83.7%)精液检查有不同程度的改善,11例(25.6%)妻子妊娠。11例附睾水平梗阻性无精子症行输精管附睾吻合术后,6例(54.5%)精液检查检出活精子,3例(27.3%)妻子妊娠。结论:精液分析、精浆果糖和中性α葡糖苷酶测定,TRUS和输精管造影是诊断梗阻性无精子症的主要方式。TURED和输精管附睾吻合术分别是治疗射精管梗阻性无精子症和附睾水平梗阻性无精子症的有效方法。     

Transurethral resection of ejaculatory duct in infertile men: outcome and predictors of success

Objectives

To evaluate the outcome of transurethral resection of the ejaculatory duct (TURED) in the treatment for ejaculatory duct obstruction (EDO) and define predictors of success.

Materials and methods

We retrospectively evaluated 23 infertile men between 2006 and 20011, who were diagnosed as having EDO. Inclusion criteria were azoospermia or oligozoospermia, low ejaculate volume, low ejaculate PH, little or no fructose in seminal plasma with normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonography (TRUS) or magnetic resonance images (MRI). Seventeen patients were diagnosed as complete EDO, and the remaining 6 were considered as having partial EDO. All patients were treated by TURED.

Results

Midline cysts were diagnosed in seven cases, and the remaining 16 patients had postinflammatory obstruction of ejaculatory ducts (ED). Overall, a significant improvement of semen quality was achieved after surgery. All patients with partial EDO showed improvements in semen parameters after TURED compared to 23.5?% (4/17) in those with complete EDO. Improvement in sperm count was 71.5?% and 31?% for patients with midline cysts and patients with non-cystic causes of EDO, respectively. Six (26?%) patients developed complications including epididymo-orchitis in 2, watery ejaculate in 3 and conversion to azoospermia in 1. Spontaneous pregnancies were achieved in 3 (13?%) cases: 2 (33.3?%) men with partial and 1 (5.9?%) with complete obstruction.

Conclusion

Partial EDO, whatever the etiology, has an excellent outcome after TURED. Complete EDO due to cysts appears to respond better than postinflammatory obstruction to TURED.     

Ejaculatory duct obstruction

Ejaculatory duct obstruction presents with infertility, pain, or hematospermia. Partial or functional forms of ejaculatory duct obstruction can be difficult to diagnose. Transrectal ultrasound has replaced formal vasography as the first-line diagnostic test but is not specific. Adjunctive procedures such as seminal vesicle aspiration, seminal vesiculography, and chromotubation further delineate the diagnosis. Using an evidence-based approach, this article reviews how best to approach the diagnosis and treatment of ejaculatory duct obstruction.     

Cysts of the prostate, seminal vesicles and diverticulum of the ejaculatory ducts.

The close proximity of the prostate, vas deferens, seminal vesicles and ejaculatory ducts are a diagnostic challenge to the cysts located in that region. Three patients with diverticulum of the ejaculatory ducts, 2 with prostate cysts and 1 patient with seminal vesicle cyst are presented. Transrectal ultrasound, computed tomography and magnetic resonance imaging together with aspiration of the cyst establish diagnosis and probably prevent unnecessary exploration.     

Fertility Restoration by Seminal Tract Washout in Ejaculatory Duct Obstruction

A complex case of secondary sterility due to excretory azoospermia-dry ejaculation is reported. Transrectal ultrasonography and vaso-vesiculography revealed post-inflammatory total obstruction of the right ejaculatory duct. Excluding small radiolucent concrements in the seminal vesicle, no anatomical anomalies were identified on the left side. By performing antegrade seminal tract washout with saline solution it was possible to clear both seminal ducts and restore fertility in our patient. In select cases seminal tract washout may be a valid alternative to the conventional transurethral surgical approach for acquired obstruction of the ejaculatory ducts.     

Ejaculatory Duct Obstruction after Transurethral Resection of the Prostate

Transurethral resection of the prostate is currently the most commonly employed surgical procedure for benign prostatic hyperplasia. Although several complications after the procedure have been well documented, ejaculatory duct obstruction is a rare complication. We describe this unusual complication in a 77-year-old male who presented with severe pain and a feeling of fullness in the lower abdomen and with dry ejaculate on three occasions after undergoing post-transurethral resection of the prostate. The patient’s post-ejaculatory urinalysis demonstrated no sperm. Transrectal ultrasonography also showed no dilatation of the bilateral seminal vesicles or ejaculatory ducts. However, ejaculatory duct obstruction was finally diagnosed on vasovesiculography. The patient was successfully treated with transurethral resection of the ejaculatory duct and remained asymptomatic 6 months postoperatively. Although transrectal ultrasonography is currently widely used to evaluate ejaculatory duct obstruction, we suggest that vasovesiculo-graphy is still a feasible and useful tool that provides detailed anatomic information for the advanced confirmation of ejaculatory duct obstruction in patients with a high suspicion of ejaculatory duct obstruction who have normal transrectal ultrasonography findings.     

TRIANGULATION END-TO-SIDE VASOEPIDIDYMOSTOMY

Purpose

A technique and the preliminary results of triangulation vasoepididymostomy are described.

Materials and Methods

Triangulation vasoepididymostomy is performed by placing 3 double-armed 10-zero nylon sutures into the epididymis so that each suture forms 1 side of a triangle. An opening in the tubule is made between the sutures and they are brought inside-out, invaginating the epididymal tubule into the vas deferens.

Results

Triangulation end-to-side vasoepididymostomy was performed bilaterally in 12 men, and sperm was found in the postoperative ejaculate of 11 (92%). Operative time was 156 +/− 14 minutes.

Conclusions

Triangulation vasoepididymostomy is reasonably successful in restoring sperm to the ejaculate and should be considered as an alternative method of vasoepididymostomy.     

SEMINAL TRACT OBSTRUCTION CAUSED BY CHILDHOOD INGUINAL HERNIORRHAPHY: RESULTS OF MICROSURGICAL REANASTOMOSIS

Purpose

Childhood inguinal herniorrhaphy is a frequent causes of seminal tract obstruction. We investigate the characteristics of this obstruction, surgical techniques for reanastomosis and outcomes in patients with bilateral or unilateral obstruction caused by inguinal herniorrhaphy in childhood.

Materials and Methods

We treated 22 men an average of 30.5 years old in whom average duration of obstruction was 27.1 years. Obstruction was bilateral in 9 patients and unilateral in 13, and 14 had azoospermia preoperatively. Microsurgical 2 layer vasovasostomy and/or specific tubule epididymovasostomy was performed.

Results

Inguinal and crossed vasovasostomy was done in 18 and 4 patients, respectively. The distal end of the vas was found at the internal inguinal ring or in the pelvic cavity in 57.1% of the vasa and more than 3 cm. of the vas had been resected in 37%. Sperm was noted in vasal fluid in 45.2% of the vasa during the operation and the patency rate of inguinal vasovasostomy was 88.9%. Ipsilateral epididymovasostomy performed after patent inguinal vasovasostomy in 5 patients with secondary epididymal obstruction resulted in normal sperm density and 3 pregnancies. In 7 men more than 2 procedures were done. There was sperm in the ejaculate in 12 of the 14 patients who had had azoospermia preoperatively and apparently increased sperm density postoperatively in 4 of the 8 who had not had azoospermia preoperatively. Pregnancy was achieved by 7 of the 21 married men (33.3%).

Conclusions

Microsurgical reanastomosis of the seminal tract resulted in high patency and pregnancy rates in cases of seminal tract obstruction caused by childhood inguinal herniorrhaphy. Patients should elect seminal tract reanastomosis or assisted reproductive technology using epididymal or testicular sperm after receiving sufficient information on each treatment modality.     

Microsurgical vasoepididymostomy with sperm cryopreservation for future assisted reproduction

BACKGROUND: Although obstructive azoospermia is treatable with microscopic seminal reconstruction, the number of patients who choose to undergo vasoepididymostomy is limited because of recent advances in assisted reproductive technology (ART). We attempted to define the outcome of surgical reconstruction in patients with suspected epididymal obstruction and no previous history of vasectomy. METHODS: We described 40 eligible end-to-side vasoepididymostomy procedures performed on 24 azoospermic patients who had either bilateral or unilateral epididymal obstruction. RESULTS: The overall patency rate following surgery was 54% (13/24) and for four patients (17%), natural intercourse resulted in pregnancy. Two pregnancies were initiated with intracytoplasmic sperm injections using frozen sperm collected during vasoepididymostomy. CONCLUSIONS: In the era of modern ART, microsurgical vasoepididymostomy with cryopreservation of sperm collected during the operation is recommended for patients with epididymal obstructions.     

Seminal vesicle sperm aspiration in the diagnosis of ejaculatory duct obstruction

OBJECTIVE: To determine the effectiveness of seminal vesicle aspiration in the diagnosis and treatment of patients with ejaculatory duct obstruction. PATIENTS, SUBJECTS AND METHODS: Between March 1998 and February 1999, 10 infertile men with ejaculatory duct obstruction (EDO, mean age 32.7 years, range 25-47) and 10 fertile volunteers (mean age 33.2 years, range 25-42) underwent transrectal ultrasonography (TRUS) and TRUS-guided seminal vesicle aspiration. The volume of and presence of motile sperm in the aspirate was compared with the TRUS findings for both groups. RESULTS: From TRUS of the patients with EDO, the mean (sd, range) transverse diameter of the right and left seminal vesicles were 1.97 (0.54, 0.8-2.6) cm and 1.93 (0.53, 0.9-2.6) cm; the corresponding values in the control group were 1.03 (0.15, 0.8-1.3) cm and 1.0 (0. 12, 0.8-1.4) cm, respectively (P<0.001). In all, 20 aspirate samples were obtained from the patients with EDO by bilateral seminal vesicle aspiration and only one (10%) had no sperm within the aspirate fluid. Of these 10 patients, two had immotile sperm and the remaining seven (14 samples) had a mean motile sperm count of 0.63 (0.45, 0.1-1.0)x106 /mL, whereas seven of eight men assessed in the control group had no motile sperm (one patient had immotile sperm within the aspirate fluid); this difference was significant (P<0.01). CONCLUSIONS: The aspiration of significant numbers of motile sperm from the seminal vesicles suggests the presence of distal obstructions of the ejaculatory duct and enables infertile couples to be candidates for assisted reproduction. However, there is a need for further research to determine the use of this technique in the diagnosis of partial EDO.