To Compare The Clinical Efficacy Of Different Surgical Methods In The Treatment Of Azoospermia Due To Ejaculatory Duct Obstruction

Objective:To compare the clinical efficacy of transurethral electrocision of ejaculatory duct orifice and seminal vesiculotomy in the treatment of azoospermia caused by ejaculatory duct obstruction,retrospectively analyze the differences in semen quality and seminal plasma biochemical changes before and after surgery,postoperative complications,recurrence rate,and pregnancy rate of infertile patients partners,and compare the therapeutic effects of the two surgical methods.To provide a reference for the selection of surgical methods for the treatment of ejaculatory duct obstructive azoospermia in the future.Methods:From January 2019 to June 2022,79 patients diagnosed with ejaculatory duct obstructive azoospermia in the Urology department of our hospital due to infertility were selected,aged 20-36 years,with an average age of（29.3±3.47）years.The patients were divided into group A（38 cases）and group B（41 cases）according to the surgical methods.The patients in group A were treated with transurethral electrocision of ejaculatory duct and the patients in group B were treated with seminal vesiculoscopy.Semen quality and biochemical analysis of seminal plasma were performed before and3 months after the operation.Sperm density,semen volume,p H value,time of semen liquefication,semen berry sugar and neutralα-glucosidase were observed.Results:1.There was no significant difference in preoperative general data between the two groups（P>0.05）.2.In group A,there were 8 cases of prostatic utricle calculi,18 cases of dark red jelly-like semen,3 cases of ejaculatory duct cyst and 1 case of prostatic utricle cyst.In group B,there were 15 cases of prostatic vesicle stones or seminal vesicle stones,22cases of seminal vesicle congestion or dark red jelly like semen,5 cases of ejaculatory duct cysts,2 cases of prostatic vesicle cysts and 1 case of seminal vesicle cyst.3.There was no significant difference in sperm density between the two groups at 3months after surgery（t=-0.811,P=0.420）.4.The semen volume,p H value and liquefaction time of the two groups before a nd 3 months after surgery were compared respectively.Only the semen p H value and liquefaction time of the 3 months after surgery were statistically different b etween the two groups（t₁=7.601,t₂=6.098,P₁<0.001,P₂<0.001）,and there were no statistically significant differences between the other groups（P>0.05）.The differences within the group were statistically significant（P<0.001）.Comp ared with the difference of semen volume,p H value and time of liquefication be fore and after surgery in group A and group B,only the difference of semen vo lume was not statistically significant（t=0.614,P=0.541）,but the difference of se men p H value and time of liquefication were statistically significant（t₁=4.425,t₂=4.389,P₁<0.001,P₂<0.001）.5.At the 3rd month after operation,there were 17 cases of abnormal white blood cells and 15 cases of abnormal red blood cells in group A;There were 8 cases and 5 cases in group B,respectively,and the difference was statistically significant（X₁²=5.801、X₂²=7.762,P₁=0.016、P₂=0.005）.6.Seminal plasma biochemistry examination at 3 months after operation showed that there was no significant difference in the content of fructose and neutralα-glucosidase between group A and group B（t₁=0.169、t₂=-0.691,P₁=0.867、P₂=0.492）.7.At 3 months after operation,there were 13 cases of hydrocele and epididymitis in group A,and 11 cases of restenosis.There were only 2 cases of epididymitis and 3 cases of restenosis in group B,and the differences were statistically significant（X₁²=11.031,X₂²=6.328,P₁=0.001,P₂=0.012）.The pregnancy rate was 7/38（18.42%）in group A and19/41（46.34%）in group B after 1 year of follow-up,and the difference was statistically significant（X²=6.963,P=0.008）.8.The average operation time of group A was（28.11±6.73）min,and that of group B was（49.46±7.19）min.The difference between the two groups was statistically significant（t=-13.606,P<0.001）.The average length of hospital stay was（9.37±1.62）days in group A and（7.07±0.85）days in group B,and the difference between the two groups was statistically significant（t=7.98,P<0.001）.Conclusions:1.Both transurethral electrocision of ejaculatory duct orifice and transurethral seminal vesiculotomy can effectively improve semen quality and seminal plasma biochemical parameters in patients with ejaculatory duct obstructive azoospermia,suggesting that surgical treatment should be active for the patients with ejaculatory duct obstructive azoospermia.2.In the treatment of ejaculatory duct obstructive azoospermia,seminal vesiculoscopy can better reduce the occurrence of postoperative complications,and reduce the postoperative recurrence rate.3.Seminal vesiculoscopy has the advantages of small surgical trauma,high pregnancy rate,rapid recovery and short hospital stay,which is worthy of clinical promotion.4.When the treatment of ejaculatory duct obstructive azoospermia by seminal vesiculoscopy fails,transurethral electrotomy of the ejaculatory duct can be used to relieve the obstruction.