经尿道射精管口电切术治疗射精管梗阻性无精子症

目的 探讨经尿道射精管口电切术（TURED）治疗射精管梗阻性无精子症的可行性和疗效。方法 对我院2003年6月—2004年12月收治的20例射精管梗阻性无精子症患者,采用精液常规分析、精浆果糖测定和经直肠前列腺精囊超声检查（TRUS）进行诊断,20例患者的精液量0．4～1．6ml,pH值6．0～7．2,精液中均未检出精子,精浆果糖为0～2．6μmoL／1次射精,其中16例的精浆果糖为0。TRUS显示前列腺中线囊肿11例,偏心性囊肿2例,双侧精囊及射精管扩张5例,一侧精囊及射精管扩张2例。所有者均使用TURED治疗,术后随访其疗效。结果 20例均完成手术,手术时间15～50min,术中出血约10～30m1,术后保留导尿管1～7d。术后随访超过3个月的15例患者中,10例（67％）术后精液质量改善,其中3例（20％）患者的配偶妊娠;随访不足3个月另尚未行精液检查。结论 TURED方法简单、安全、有效,是治疗射精管梗阻的有效手段。

Surgical therapy for azoospermia with ejaculatory duct obstruction

OBJECTIVE: To investigate the effect of transurethral resection of ejaculatory ducts (TURED) for azoospermia with ejaculatory duct obstruction (EDO). METHODS: From June 2003 to December 2004, 20 azoospermia with EDO were diagnosed, diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, endocrine assessment, testicular biopsy and transrectal ultrasonography (TRUS); All 20 cases were treated by TURED. Fifteen of them were followed up more than 3 months after the treatment. The semen samples of them were analysed at 3-month intervals in post-therapy. RESULTS: Semen analyses in all 20 cases showed the typical characteristics of EDO, low semen volume (0.4-1.6 ml), azoospermia, low pH, absent or low semen fructose. TRUS showed the main etiology factor of EDO was a midline cyst in 11, lateral cystic lesions in 2, the remaining 7 cases had dilated ejaculatory duct with or without dilated seminal vesicles. Among 15 cases followed up more than 3 months after TURED, 10/15 (67%) had an improvement in semen parameters and 3/15 (20%) had pregnancies. Semen analyses had not been done in anther 5 cases. CONCLUSION: Transurethral resection of ejaculatory ducts may be a safe and effective method for the treatment of azoospermia with EDO.