Male Infertility Related To Ejaculatory Duct Obstruction And Congenitalabsence Of The Vas Deferens

Background and Objectives: Ejaculatory duct and vas deferens are the major components of seminal tract,which originated from the mesonephric duct during embryonic development.The congenital and acquired anatomical abnormalities or dysfunction caused can lead to male infertility.Among them,ejaculatory duct obstruction(EDO)and congenital absence of the vas deferens(CAVD)are common in clinic.However,the systematic clinical diagnosis and treatment remains to be standardized.From the clinical points of view,we carried on the research of the normal anatomy of distal seminal tracts,explored the application of seminal endoscopic incision with thulium laser in the treatment of ejaculation ejaculatory duct,and summarized the clinical and genetic features of congenital absence of the vas deferens.Materials and Methods: Surgical specimens of prostate cancer and patients with EDO or CAVD were collected from March 2015 to December 2016 in Shanghai General Hospital.The study can be divided into following three parts:1.3 surgical specimens of early prostate cancer were dissected to observe the anatomy of the ejaculatory duct,seminal vesicle and distal segment of vas deferens,and the length of ejaculatory duct was measured;2.The data of 15 cases of EDO was analyzed,and the effectiveness and complications of transurethral insection of the the ejaculatory duct(TUIED)with thulium laser were evaluated;3.The data of 41 cases of CAVD was analyzed.Genomic DNA of blood samples from 21 CAVD patients was extracted.5T and F508 alleles polymorphyism were detected by polymerase chain reaction(PCR),and the PCR products were sequenced.Results:1.The seminal vesicle and the ampulla of the vas deferens were incorporated to form the ejaculatory duct which went through the central zone of prostate and entered the urethra besides the verumontanum.The average length of normal ejaculatory duct was 11.6±0.4mm;2.15 patients with EDO were treated with transurethral insection of the ejaculatory duct by thulium laser.The semen quality of 11 cases improved,of which 1 patient’s wife achieved natural pregnancy and 1 pregnant by ICSI,5 got no improvement,and 1 case was lost in the follow-up;3.41 cases of patients with CAVD patients varied manifestations.40(97.6%)of which got Sperm in sperm retrieval,while one failed in sperm extraction was diagnosed as spermatogenic maturation arrest.4 CUAVD patients who had strong demand of natural pregnancy underwent micro-vasoepididymostomy(VE)or transseptal crossover VE treatments,all of which found no sperm after 1~6 months follow-up;12 cases were treated with ICSI,7 of which fathered their their children,and 2 wives of which were pregnant.42.9% patients(9/21)were detected 5T allele in the polythymidine tract of intron 8.ΔF508del mutation was not found in any patients.Conclusions: The anatomy of the distal seminal tracts was the basis for understanding the pathogenesis,clinical manifestation and surgical approach of EDO.Seminal endoscope combined with TUIED with thulium laser was an efficient treatment for EDO.The diagnosis of CAVD should be paid attention to the evaluation of of clinical features,laboratory tests,ultrasound and other imaging examinations.Sperm retrieval combined with ICSI was the ideal approach for CAVD.CUAVD patients could undergo microsurgical seminal duct reconstruction,but the patent rate stayed indefinite because of the limited cases.There were differences in CFTR gene mutation between Chinese Han and Caucasian CAVD groups.A new sequencing strategy to explore the causes and pathogenesis of CAVD remained to be further studied.