How is ejaculatory duct obstruction diagnosed?

    Ejaculatory duct obstruction is difficult to diagnose. Complete obstruction or partial obstruction may exist. Complete obstruction is easier to diagnose. The diagnosis of complete or partial ejaculatory duct obstruction is based on the patient's history coupled with the tests listed below.

    The following tests have been used to diagnose ejaculatory duct obstruction.

1. Semen analysis
2. Transrectal ultrasound of the prostate (TRUS)
3. MRI of the prostate and seminal vesicles
4. Vasogram
5. Seminal vesiculogram
6. Seminal vesicle washout – this may be the most sensitive test
7. Post ejaculatory urine analysis.

    Men with suspected ejaculatory duct blockage often first undergo a transrectal ultrasound. This is a procedure that today, can be done in the office. An ultrasound probe is placed in the rectum. The probe is approximately the size of a finger and the test is comparable to a rectal exam. The ultrasound may show a dilated seminal vesicle or a dilated ejaculatory duct. Unfortunately TRUS is not sensitive enough to diagnose all cases of ejaculatory duct obstruction or to diagnose partial ejaculatory duct obstruction.