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A Systematic Review of Transurethral Resection of Ejaculatory Ducts for the Management of Ejaculatory Duct Obstruction

Research output: Contribution to journalArticle

Ayah Mekhaimar, Mary Goble, Oliver Brunckhorst, Hussain Alnajjar, David Ralph, Asif Muneer, Kamran Ahmed

Original languageEnglish
Pages (from-to)335-347
Number of pages13
JournalTurkish Journal of Urology
Volume46
Issue number5
DOIs
Accepted/In press16 Jul 2020
Published1 Sep 2020

Documents

  • TURED_SR_TurkJU

    TURED_SR_TurkJU.pdf, 528 KB, application/pdf

    Uploaded date:01 Sep 2020

    Version:Final published version

King's Authors

Abstract

Objective: Ejaculatory duct obstruction (EDO) is an uncommon but potentially treatable cause of male factor infertility. However, there are limited data on transurethral resection of the ejaculatory ducts (TURED) as a treatment option. A systematic review was therefore conducted to assess its efficacy and identify patient subgroups that benefit from the procedure.
Material and methods: A database search of PubMed, Embase, and Scopus (up to January 2019) and the World Health Organization trial registry was performed to identify all studies assessing infertile men with EDO undergoing TURED. The primary outcome measures included semen parameters and natural pregnancies. The secondary outcomes included complications, symptomatic improvement, and a change from in vitro fertilization to intrauterine insemination.
Results: Of 3,277 articles screened, 29 studies with 634 patients were included in the study. Although outcomes varied considerably among studies, a general increase in all semen parameters postoperatively was observed. Semen volume (n=23 studies) improved in a median of 83.0% of patients (interquartile range [IQR]: 37.5). Sperm motility and concentration (n=10 and n=21 studies) improved in a median of 63.0% (IQR: 15.0) and 62.5% (IQR: 16.5) of patients, respectively. The natural pregnancy rate across the studies was a median of 25.0% (IQR: 15.7). Improvements in both the outcomes were greater in patients with congenital etiologies and partial EDO. Differences in surgical technique did not appear to affect outcomes.
Conclusion: TURED is associated with improvements in semen parameters and offers a chance of restoring fertility in previously subfertile men. Although results are promising, the current evidence remains limited owing to predominantly retrospective studies with small sample sizes.

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