TRUS in Evaluation of Male Infertility
54 likes16,347 views
Transrectal ultrasound (TRUS) is a key diagnostic tool in evaluating male infertility, particularly for examining abnormalities in the ejaculatory duct system. It aids in identifying obstructions and has largely replaced vasography in certain assessments, enabling better surgical planning and possible therapeutic interventions. TRUS provides a detailed real-time image of the reproductive anatomy and is effective in diagnosing conditions like azoospermia and ejaculatory duct obstruction.
TRUS in Evaluation of Male Infertility
- 1. Role of Transrectal Ultrasound (TRUS) in Male Infertility Dr. Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital
- 2. What is TRUS ? Ultrasound probe placed within rectum 7 MHz frequency, higher frequency, shorter penetration, better resolution Complete picture of prostate, seminal vesicles and ejaculatory duct in real-time, by moving a few millimeters on transverse or longitudinal plane
- 3. TRUS
- 4. TRUS Sagital Transverse 135 Degrees
- 5. Role of TRUS in male infertility Evaluation of abnormalities of ejaculatory duct apparatus Able to determine level of obstruction in ejaculatory duct, aids in planning surgery Ultrasound guided aspiration – cyst, seminal vesicle fluid Almost replaced vasography in evaluation of ejaculatory duct obstruction Vasography still necessary if classical characteristics not present on TRUS
- 6. Anatomy of ejaculatory duct 3 parts of ejaculatory duct: Long, extra-prostatic Middle, intra-prostatic Distal, joining verumontanum in urethra Ejaculatory duct obstruction may be present in 5% of subfertile men
- 7. Indications for TRUS in infertile males L ow ejaculate volume Z ero (azoospermia) or a decreased (oligospermia) number of sperm in the ejaculate S ignific a nt sperm motility abnormalities H istory of prostate infections, prostatitis
- 8. Clinical suspicion of diagnosis of ejaculatory duct obstruction Azoospermia Hematospermia Painful ejaculation Perineal pain Urinary tract infections or trauma
- 9. Causes of ejaculatory duct obstruction Seminal vesicle stones Mullerian duct (utricular) cysts Wolffian duct (diverticular) cysts Post-surgical scar tissue Post-inflammatory scar tissue Calcification (stone) near the verumontanum Congenital atresia Functional obstruction (alpha blocker, anti-psychotic, anti-depressants)
- 10. Diagnosis of ejaculatory duct obstruction Azoospermia E jaculate volume <2.0 ml and a pH<7.2 that contains no sperm or fructose. Normal serum FSH and testosterone. Testicular of normal size (20cc) and consistency.
- 11. TRUS diagnosis of ejaculatory duct obstruction D ilated seminal vesicles (>1.5 cm width) D ilated ejaculatory ducts (>2.3 mm) C yst, calcification or stones along the duct TRUS and seminal vesicle aspiration showing the presence of sperm in the seminal vesicle fluid within 2 days of ejaculation
- 12. Technique Left lateral position DRE Introduction of rectal ultrasound probe No anaesthesia required Mild sedation for drainage or aspiration
- 13. Transverse plane Prostate evaluation Base to apex Emphasis on base and mid prostate Seminal vesicle Small amount of urine in bladder is helpful
- 14. Prostate Bladder
- 18. Ejaculatory duct
- 19. Prostatic cyst, infartion
- 20. Sagittal Plane Bladder neck Urethra Verumontanum Ejaculatory duct Seminal vesicles, one at a time
- 22. Urethra
- 23. Ejaculatory duct
- 24. D ilated ejaculatory ducts (>2.3 mm)
- 25. D ilated seminal vesicles (>1.5 cm width)
- 26. Aspiration from seminal vesicles or cysts Negative urine culture Mild sedation - midazolam Prophylactic antibiotics - 6 to 24 hours prior to aspiration e.g. ciprofloxacillin 500 mg - i/v gentamicin 160 mg before aspiration Continue oral antibiotics for another 3-5 days
- 27. TRUS aspiration of utricular cyst
- 28. TRUS – ejaculatory duct obstruction
- 29. Conclusions TRUS is the ideal instrument for evaluation of ejaculatory duct disorders Fast replacing vasography Excellent planning for surgery Option of aspiration from seminal vesicle (diagnostic) or urticle cyst (therapeutic)
- 30. Thank you