Yonsei Med J.  2013 Jul;54(4):1062-1065. 10.3349/ymj.2013.54.4.1062.

Hybrid Method of Transurethral Resection of Ejaculatory Ducts Using Holmium:Yttriumaluminium Garnet Laser on Complete Ejaculatory Duct Obstruction

• Lee JY
• Diaz RR
• Choi YD
• Cho KS

• KMID: 2158247
• DOI: http://doi.org/10.3349/ymj.2013.54.4.1062

Abstract

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.

Keyword

Ejaculatory ducts; semen analysis; infertility; holmium

MeSH Terms

Adult
Azoospermia/diagnosis/physiopathology/surgery
Ejaculatory Ducts/abnormalities/*surgery/ultrasonography
Holmium
Humans
Infertility, Male/physiopathology/*surgery
Laser Therapy/*methods
Male
Treatment Outcome
Urethra
Yttrium
Holmium
Yttrium

Figure

• 

  Fig. 1 Transrectal ultrasonography revealed (A) a midline prostatic cyst with an approximate diameter of 1.5 cm (white arrow) with (B) dilated seminal vesicles.

• 

  Fig. 2 T2-weighted magnetic resonance image and seminal vesiculography. (A and C) Approximately 2 cm sized cystic lesion (white arrows) was located in the prostate. (B, C and D) Mild dilatation of the seminal vesicles was observed. (E) The seminal vesicles and midline cyst (white arrow head) were filled with contrast media under seminal vesiculography.

• 

  Fig. 3 Hybrid technique for complete ejaculatory duct obstruction. (A) Small space of the prostatic urethra. (B) Using Ho:YAG laser with a 550 µm laser fiber (Lumenis, Yokneam, Israel), unroofing of midline prostate cyst was performed. (C) Using TUR, the cystic wall was completely resected and a guidewire was inserted through the ejaculatory duct. (D) The ejaculatory ducts and its wall were visualized using a 6.5 Fr semi-rigid ureteroscope (Richard Wolf GmbH, Knittlingen, Germany). Ho:YAG, holmium:yttriumaluminium garnet; TUR, transurethral resection.

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