Transurethral Resection of Ejaculatory Duct for Obstructive Azoospermia Due to Prostatic Calculi: Diagnosis and Surgical Management

P. A. Soffner - Cardoso, D. P. C. Mesias, R. A. S. Pinto, R. V. Juliano, S. Glina, L. Seligra - Lopes

Ejaculatory duct obstruction, azoospermia, male infertility, seminal vesicle, prostatic calcification, transurethral resection

Obstructive azoospermia (OA) accounts for up to 40% of azoospermia cases, and ejaculatory duct obstruction (EDO) is a rare but potentially curable cause, representing 1–5% of OA cases. This video presents the case of a 38-year-old man with primary infertility, normal hormone levels, preserved spermatogenesis, and no genetic abnormalities. Two semen analyses showed persistent azoospermia with low ejaculate volume. Transrectal ultrasound revealed slightly enlarged seminal vesicles and central prostatic calcifications. Pelvic MRI confirmed the presence of ejaculatory duct obstruction caused by prostatic calculi, without associated cysts. The patient underwent transurethral resection of the ejaculatory ducts (TURED) with intraoperative transrectal ultrasound guidance. A needle puncture of the seminal vesicle confirmed the presence of sperm and facilitated the injection of methylene blue to localize the ducts endoscopically. Upon resection, a visible release of methylene blue and seminal fluid containing microcalculi confirmed ductal patency. The patient was discharged the same day, and semen analysis at three months postoperatively showed normalization of ejaculate volume and sperm count. This case highlights a minimally invasive, effective approach to treating rare EDO secondary to prostatic calcifications, avoiding unnecessary assisted reproductive techniques and preserving the natural fertility pathway.

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