ULTRASONIDO TRANSRECTAL COMO GUÍA PARA EL DIAGNÓSTICO Y TRATAMIENTO DE LA OBSTRUCCIÓN DE LOS CONDUCTOS EYACULADORES

SUMMARY Introduction. The male infertility is caused by obstruction of the seminal tract (ST) in 10 % of the cases. When this obstruction occurs at the ejaculatory ducts (EDO), the transurethral resection (TUR) of the verumontanum turns out to be an effective therapy. The purpose of this work is to demonstrate the utility of the transrectal intraoperative ultrasonogra- phy (TIUS) and the transrectal contrasted injection in the ST under radioscopy (RX) in order to determine the cause and location of the EDO and to facilitate the TUR, leading the resectoscopy precisely towards the place of obstruction. Material and Methods: Between June, 2001 and April, 2004, 7 patients were evaluated with suspicion of EDO. All of them submit normal physical examination, spermogram with hypospermia (5 = oligozoospermia and 2 = azoospermia) and dilation of the seminal vesicles (SV). The technique was the puncture of the dilated portion of the ST and the injection of iodine contrast and blue of methylene solution under USTr, RX and urethroscopy. As soon as the place of obstruction was determined, the TUR was carried out, and its course and size were determined by the USTr. The thera- peutic success was based on the improvement of the spermogram. Results. All patients (7/7) had a diagnosis, being cysts from the half-line (n=4) stenosis of the ejaculator duct (SCD) bilateral (n=1), unilateral (n=1) and hypotony of SV (n=1). Except for the last one (functional obstruction), they all were submitted to TUR without complications. In all the treated patients (6/7) the spermograms had improved to the desired values. Conclusion. The TIUS is a useful method to determine the cause and the place of obstruction of the ST. It allows to guide the diagnostic puncture and to facilitate the TUR, setting precisely and at the same time the place and course of resection. Thus, surgeries are performed with a minor area of resection and a lesser number of potential complications.