Scintigraphic evaluation of distal ejaculatory duct obstruction after sulphur colloid injection into the seminal vesicles

2. ABSTRACTThe Scintigraphic Evaluation of Distal Ejaculatory Duct Obstruction AfterSulphur Colloid Injection Into the Seminal Vesicles.Ejeculatory duct obstruction (EDO) is detected as an aetiologic factor in 1-5 % ofmale infertility cases. In the last years, the development of noninvazive diagnosticmethods directed the interest to the evaluation of the infertile patients with azoospermiaor oligoasthenozoospermia, palpable vas deferens and normal testis volume accordingto distal obstruction. With the radiodiagnostic methods like TRUS, it is reported thatbeside the correctible mechanical obstructive pathologies at the ejeculatory duct level,also functional obstructions at this level could be a reason for infertility.For the evaluation of the infertile patients with distal obstruction, there is stillnot a gold standart diagnostic method. Methods like aspiration,vesiculography andchromotubation are developed,but there is still no diagnostic method to evaluate thedistal functional obstruction. In this study it was aimed to determine the role of dynamicscintigraphic diagnosis after TRUS guided seminal vesicle aspiration in the evaluationof distal obstructive infertility.20 patients who applied to the andrology polyclinic because of infertility, whichhad no additional infertility pathologies other than distal obstruction after theirandrological investigation, were taken into the study. The patients were divided into twogroups. Group 1:Patients with signs of anatomic obstruction.(TRUS+) (n=11), Group2:Patients without any sign of an obstruction.(TRUS-) (n=9).TRUS guided seminal vesicle aspiration was performed with a 17 cm. 22Gauge(G)Chiba needle.2 cc. of Technesium -99m sulfur colloid (Tc-99mSC) wasinjected to both of the seminal vesicle after aspiration and the first scintigraphy processwas performed. After the ejeculation the second scintigraphic image was taken.A statistically significant difference between Group 1 and Group 2 was detected(p>0.05). 11 of the 20 patients (%55) showed pathological findings related to distalejeculatory ductus obstruction. In 10 (%91) of the 11 patients with TRUS(+) resultssigns of obstruction was detected in the Tc-99m scintigraphic images. And 3 (%33) of 9TRUS(-) patients had signs of functional obstruction in the Tc-99m scintigraphy.In the diagnosis of the distal ejeculatory ductus obstruction, static tests could besufficient for the diagnosis of the anatomic obstructions, but for the diagnosis offunctional obstruction there is a need of additional dynamic testsKey Words: TRUS, scintigraphy, obstruction