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TRUS in Evaluation of Male Infertility
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TRUS in Evaluation of Male Infertility

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Dr Ho Siew Hong lectured in the Andrology Certification Workshop as part of 3rd Japan-ASEAN Men's Health and Aging Conference on 29 Nov 08

Dr Ho Siew Hong lectured in the Andrology Certification Workshop as part of 3rd Japan-ASEAN Men's Health and Aging Conference on 29 Nov 08

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TRUS in Evaluation of Male Infertility TRUS in Evaluation of Male Infertility Presentation Transcript

  • Role of Transrectal Ultrasound (TRUS) in Male Infertility Dr. Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital
  • What is TRUS ?
    • Ultrasound probe placed within rectum
    • 7 MHz frequency, higher frequency, shorter penetration, better resolution
    • Complete picture of prostate, seminal vesicles and ejaculatory duct in real-time, by moving a few millimeters on transverse or longitudinal plane
  • TRUS
  • TRUS Sagital Transverse 135 Degrees
  • Role of TRUS in male infertility
    • Evaluation of abnormalities of ejaculatory duct apparatus
    • Able to determine level of obstruction in ejaculatory duct, aids in planning surgery
    • Ultrasound guided aspiration – cyst, seminal vesicle fluid
    • Almost replaced vasography in evaluation of ejaculatory duct obstruction
    • Vasography still necessary if classical characteristics not present on TRUS
  • Anatomy of ejaculatory duct
    • 3 parts of ejaculatory duct:
    • Long, extra-prostatic
    • Middle, intra-prostatic
    • Distal, joining verumontanum in urethra
    • Ejaculatory duct obstruction may be present in 5% of subfertile men
  • Indications for TRUS in infertile males
    • L ow ejaculate volume
    • Z ero (azoospermia) or a decreased (oligospermia) number of sperm in the ejaculate
    • S ignific a nt sperm motility abnormalities
    • H istory of prostate infections, prostatitis
  • Clinical suspicion of diagnosis of ejaculatory duct obstruction
    • Azoospermia
    • Hematospermia
    • Painful ejaculation
    • Perineal pain
    • Urinary tract infections or trauma
  • Causes of ejaculatory duct obstruction
    • Seminal vesicle stones
    • Mullerian duct (utricular) cysts
    • Wolffian duct (diverticular) cysts
    • Post-surgical scar tissue
    • Post-inflammatory scar tissue
    • Calcification (stone) near the verumontanum
    • Congenital atresia
    • Functional obstruction (alpha blocker, anti-psychotic, anti-depressants)
  • Diagnosis of ejaculatory duct obstruction
    • Azoospermia
    • E jaculate volume <2.0 ml and a pH<7.2 that contains no sperm or fructose.
    • Normal serum FSH and testosterone.
    • Testicular of normal size (20cc) and consistency.
  • TRUS diagnosis of ejaculatory duct obstruction
    • D ilated seminal vesicles (>1.5 cm width)
    • D ilated ejaculatory ducts (>2.3 mm)
    • C yst, calcification or stones along the duct
    • TRUS and seminal vesicle aspiration showing the presence of sperm in the seminal vesicle fluid within 2 days of ejaculation
  • Technique
    • Left lateral position
    • DRE
    • Introduction of rectal ultrasound probe
    • No anaesthesia required
    • Mild sedation for drainage or aspiration
  • Transverse plane
    • Prostate evaluation
    • Base to apex
    • Emphasis on base and mid prostate
    • Seminal vesicle
    • Small amount of urine in bladder is helpful
  • Prostate Bladder
  •  
  •  
  •  
  • Ejaculatory duct
  • Prostatic cyst, infartion
  • Sagittal Plane
    • Bladder neck
    • Urethra
    • Verumontanum
    • Ejaculatory duct
    • Seminal vesicles, one at a time
  •  
  • Urethra
  • Ejaculatory duct
  • D ilated ejaculatory ducts (>2.3 mm)
  • D ilated seminal vesicles (>1.5 cm width)
  • Aspiration from seminal vesicles or cysts
    • Negative urine culture
    • Mild sedation - midazolam
    • Prophylactic antibiotics - 6 to 24 hours prior to aspiration e.g. ciprofloxacillin 500 mg - i/v gentamicin 160 mg before aspiration
    • Continue oral antibiotics for another 3-5 days
  • TRUS aspiration of utricular cyst
  • TRUS – ejaculatory duct obstruction
  • Conclusions
    • TRUS is the ideal instrument for evaluation of ejaculatory duct disorders
    • Fast replacing vasography
    • Excellent planning for surgery
    • Option of aspiration from seminal vesicle (diagnostic) or urticle cyst (therapeutic)
  • Thank you