Editing Infertility: Management (section)

====Management====

===== Options =====

*'''<span style="color:#ff0000">Surgical sperm extraction</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
*'''<span style="color:#ff0000">Transurethral resection of ejaculatory ducts (TURED)</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''

===== Transurethral resection of ejaculatory ducts (TURED) =====
*Goal of the surgery is to resolve the obstruction to allow sperm to enter the ejaculate, which can be used for unassisted conception or ART
**63-83% of patients will have an improvement in semen parameters after the procedure
**In addition to fertility, investigators have reported successful treatment with TURED for other symptoms including hematospermia, recurrent infection, or pain (i.e., scrotal, post-ejaculatory).
*'''<span style="color:#ff0000">Indications'''
**'''<span style="color:#ff0000">May be offered if a seminal vesicle aspirate reveals the presence of sperm in an azoospermic male'''
*Technique
**Resection of the verumontanum will often reveal the dilated ejaculatory duct orifice or cyst cavity. Resection should be carried out in this region with great care to preserve the bladder neck proximally, the striated sphincter distally, and the rectal mucosa posteriorly.
**In men with EDO associated with Mullerian cysts, treatment involves unroofing of the cyst, resulting in decompression of the cyst and relief from extrinsic obstruction of the ejaculatory ducts.
*'''Adverse events (9):'''
*#Restenosis
*#Pain
*#Epididymoorchitis
*##Recurrent epididymitis often results in epididymal obstruction
*##*Chronic low-dose antibacterial suppression, such as that used for vesicoureteral reflux, may be necessary until pregnancy is achieved
*#Urinary retention
*#Reflux of urine into the ejaculatory ducts and seminal vesicles or substantial defects in the prostatic fossa
*##Leading to watery ejaculate and resulting in acute and chronic chemical and/or bacterial epididymitis
*##can be assessed by voiding cystourethrography or measurement of semen creatinine levels
*#Gross hematuria
*#Incontinence
*#Retrograde Ejaculation
*#*Common after TUR, even when care has been taken to spare the bladder neck
*#Urethral stricture