Abstract
Introduction and Objectives:
We aimed to study whether laser incision of obstructed ejaculatory duct confirmed by positive endoscopic seminal vesicle milking test (ESMT) would help in the restoration of fertility in patients with abnormal semen parameters.
Methods:
After obtaining ethical committee approval, we prospectively identified male patients with abnormal semen parameters secondary to obstructed ejaculatory ducts. Participants underwent history, examination, and preoperative routine investigations, including semen analysis, hormone profile, and transrectal ultrasonography. The steps of ejaculatory duct obstruction confirmation by ESMT (Omar's technique) and laser-assisted incision are declared in the attached video. We used 4.5F ureteroscope (Ultra-Thin; Richard Wolf GmBH, Knittlingen, Germany) for entering the ejaculatory duct and Revolix duo 120/20 (LISA laser products; OHG, Germany) for both stone disintegration (Holmium 0.8 J*15 Hz) and incision of duct (Thulium 20 watt).
Results:
A total of six patients were included after positive ESMT with a mean age of 33 ± 4 years. Their mean semen volume was 1.2 ± 0.3 mL per ejaculate, semen concentration 10.2 ± 3.2 per million per milliliter, and mean progressive motility 13.6 ± 7.5. Mean operative time was 17 ± 11 minutes, and at 3-, 6-, and 12-month follow-up after surgery, all semen parameters were significantly improved with a 34% of conception rate.
Conclusion:
The ESMT is a beneficial test to avoid unnecessary manipulation within proposed cases of ejaculatory duct obstruction. Transurethral incision of the obstructed ejaculatory duct by laser has proved a short-term improvement in semen parameters and conception rates.
No competing financial interests exist.
Runtime of video: 7 mins 2 secs
Consent: Corresponding author has received and archived patient consent for video recording/publication in advance of video recording of procedure.
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