Imaging in male-factor obstructive infertility

The main purpose of imaging evaluation in male infertility is to identify and treat correctable causes of infertility, such as obstruction of the seminal tract. Various imaging modalities are available to evaluate men with obstructive infertility including scrotal ultrasonography, transrectal ultrasound (TRUS), vasography, magnetic resonance imaging, seminal vesicle aspiration, seminal tract washout, and seminal vesiculography. To date the most reliable and accurate diagnostic technique for obstructive infertility is unclear. In this review article, we report the role of these modalities in diagnosis of obstructive infertility. Scrotal sonography is the initial modality, and if patient results indicate non obstructive azoospermia as varicocele or testicular pathology they will be treated according to standard protocols for management of these pathologies. If the patient findings indicate proximal obstructive azoospermia, they can be managed by vasoepididymostomy. If the scrotal ultrasound is normal, TRUS is the second imaging modality. Accordingly, they are classified into patients with criteria of obstructive infertility without urogenital cysts where TRUS-guided aspiration and seminal vesiculography can be performed and transurethral resection of the ejaculatory ducts (TURED) will be the management of choice. In patients with urogenital cyst, TRUS-guided cyst aspiration and opacification are performed. Ifthe cyst is communicating with the seminal tract, management will be transurethral incision of the cyst. If the cyst is not in communication, the obstruction may be relieved after cyst aspiration. If the obstruction is not relieved, TURED will be the management of choice. Sperm harvested during aspiration may be stored and used in assisted reproduction techniques. If the results of TRUS are inconclusive or doubtful, endorectal magnetic resonance imaging should be performed to serve as a "detailed map" for guiding corrective operative interventions.

Ectopic insertion of the ureter into the seminal vesicle

We present a case of left ectopic ureter insertion into the left seminal vesicle which is a rare anomaly.The incidence of ectopic insertion of the ureter is more common in females and is usually associated with incontinence,leading to the diagnosis,while in males it is present with infection.Ectopic ureter is defined as abnormal insertion of the ureter,occurring in the posterior urethra in approximately 50%of cases in males.Other sites include the seminal vesicle(approximately one-third),vas deferens,bladder neck,prostate and epididymis,while the urethra and vagina are commonly affected in females.Management is usually addressed to the upper tract only;if there is incontinence it requires removal of the ureteric stump.Our case was initially diagnosed by magnetic resonance imaging and the diagnosis confirmed by computed tomography(CT)guided seminal vesiculography as transrectal guidance for seminal vesiculography was refused by the patient.CT guided seminal vesiculography is less painful and more tolerable than the transrectal route.