WCE 2019: Systematic Review of Transurethral Resection of Ejaculatory Ducts for the Management of Obstructive Azoospermia: Outcomes and Predictors of Success

Abu Dhabi, United Arab Emirates (UAE) (UroToday.com) This presentation overviewed a systematic review that was conducted regarding transurethral resection of ejaculatory ducts to manage obstructive azoospermia. Ejaculatory duct obstruction is an uncommon cause of infertility and accounts for only 3-5% of infertility in males. It can be congenital, due to cysts or ejaculatory duct atresia, or it can be acquired through infection, inflammation, or trauma. The mainstay of treatment for this condition is transurethral resection of ejaculatory ducts, but the efficacy of this procedure is not well understood.

In this systematic review, they searched Embase, Scopus, and Pubmed. Primary research studies on infertile males with ejaculatory duct obstruction treated by this procedure. Primary outcomes had to be reported by the paper: post-procedural semen parameters such as semen volume, sperm concentration, sperm motility, natural pregnancy rates post-TURED. Complications and resolution of symptoms had to also be reported. The MINORS tool was used to assess bias and the GRADE tool was used to assess the quality of evidence.

They looked at 29 studies, with 634 participants in total. Patients with partial EDO and congenital etiologies of EDO had better outcomes in these patients. Differences in surgical technique did not change the outcomes. Unfortunately, the MINORS tool determined a high risk of bias across all studies and the GRADE tool found the quality of evidence to be rated very low, with a weak recommendation supporting the use of TURED for EDO. Translation into pregnancy was not clear.

Overall, the quality of evidence regarding transurethral resection of ejaculatory ducts for obstructive azoospermia is very low. In this low-quality evidence, however, partial EDO and congenital EDO have better outcomes. It is unclear if this translates into pregnancy for the couple.

Presented by: Ayah Mekhaimar – Medical Student, King's College London, London, England, United Kingdom

Written by: Andrew Shea Afyouni, BS, Junior Research Specialist and Medical Student, University of California, Irvine Department of Urology. Medical Writer for UroToday.com at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates