One Man's Story

After 8 years of treatment, my story has many details, but most of this is germane.

In 1999, I had the traditional surgery sometimes done to treat infertility. That is, Transurethral Resection of Verumontanum. In my understanding, this has the basic goal of enlarging the openings of the ejaculatory ducts. In my case, it had the added benefit of unroofing a utricular cyst. When operating that first time, the surgeon stopped after a single shallow cut.

When my symptoms did not really resolve from that surgery, a quick cystoscopy revealed that the "unroofed" cyst had scarred back over, again blocking the ejaculatory ducts, which in effect opened into the remaining concavity of the cyst after the first operation. A second operation, by a single shallow cut, eliminated the scar tissue and the remnant of the cyst, so that the ducts definitely open into the urethra.

At this point, after 2 surgeries, I was getting urine back into the seminal vesicle, perhaps only on one side. This concerned me at the time. I can now say:
1. The reflux of urine, by itself, is not a terrible symptom and if it had continued while all other symptoms were resolved, it would be OK.
2. The problem resolved itself. When the ejaculatory ducts are totally obstructed at the veru, fluid pressure causes them to become enlarged upstream of the obstruction. That is rather well known, I think. After the obstruction was removed, they must have returned to a more normal state, and any reflux of urine is minimal to non-existent.

After that time, in 2000 or so, I felt better but not all symptoms were resolved.

Then maybe in 2001 or 2002 I went in to see the doc, and I had a brainstorm. I told him that one duct seemed to be obstructed more than the other one, and asked if he could force salt water into each duct to unblock any obstruction. With no hesitation, he said "Yes. I can do that. And I'll use a solution that absorbs x-rays so we can verify when the duct is open." In 30 seconds, a new procedure was born.

The procedure was done in an ambulatory surgery suite with nurses and assistants and highly trained anesthesiologists running around, the same place as the earlier surgeries. Although the anesthesiologist had his salt-water line in a vein of my hand, I was able to remain awake and indeed watch the procedure on video. On my right was a color monitor showing a clear video through the cystoscope. On my left was a black-white monitor showing an x-ray picture of the prostate and seminal vesicles. On one side it was moderately easy for the doc to get a tiny catheter into the duct and inject the solution. On the other side---I think it was the patient's left at that time---the obstruction was greater and the doc had to first insert a wire, then the catheter, then increase the pressure. On both sides, as the duct opened up, the liquid flowed quickly into the seminal vesicle and on the x-ray picture, the seminal vesicle suddenly lit up. I recall it as my video game operation, and watching the 2 televisions definitely served as an anesthetic, taking my mind off the painful sensations.

After that, maybe I drifted along for a while, definitely better but still with symptoms remaining. As I began to relapse, I visited the doc and said I thought he should repeat the dilation procedure. We have done it as often as 90-day intervals, and he does it without the x-ray and the numerous highly trained personnel, in his regular clinic. It's pretty efficient if he just does it without interviews before and after.

This was very well, 90 days was about the right timing, but I was not being cured. Sometimes I had no anesthetic except the topical stuff that they use for any cystoscopy. However, I have a supply of painkillers hoarded up from years past. Sometimes, I took one Vicodin before the procedure, but even that one white pill would make me dizzy and I didn't like to take it, then drive back in moderate suburban traffic. On the other hand, I was feeling pain when he forced the salt water into the ducts, and I realized that he could do a better job if I'd take some painkiller.

On March 3, 4 weeks ago, I had an appointment for a dilation procedure. My symptoms were relapsing pretty badly and I thought I should get my money's worth by using more painkiller. I got my son Nick to drive me over there. Then right before the appointment I took 2 Percocet. That was a strong dose, and later in the day I threw up a little, but during the procedure, I was suitably dizzy and he was able to do a little more dilation, irrigation, and aspiration without the patient getting too tense and noisy. He knew that I had taken the pills, we had a whole discussion about anesthesia options. Anyway, during the procedure he said that a small stone came out.

I don't know if the stone was significant, but it seemed significant at the time, and that set me on a course of further action. Remember this was only 4 weeks ago. First I re-read an article that I had copied a few years ago:

J Urol. 1995 Jun;153(6):1948-50.
Fertility restoration by seminal tract washout in ejaculatory duct obstruction.
Colpi GM, Negri L, Patrizio P, Pardi G.
Infertility Center, San Paolo Hospital, Milan, Italy.

A complex case of secondary sterility due to excretory azoospermia-dry ejaculation is reported. Transrectal ultrasonography and vaso-vesiculography revealed post-inflammatory total obstruction of the right ejaculatory duct. Excluding small radiolucent concrements in the seminal vesicle, no anatomical anomalies were identified on the left side. By performing antegrade seminal tract washout with saline solution it was possible to clear both seminal ducts and restore fertility in our patient. In select cases seminal tract washout may be a valid alternative to the conventional transurethral surgical approach for acquired obstruction of the ejaculatory ducts.

Reviewing the procedure that these authors did, and the symptoms of the patient before and after, I realized that my whole vasa deferentia were clogged up, not flowing at all. Then I thought since the ejaculatory ducts in themselves were now well unplugged, and the small stone removed for whatever that is worth, I could try to get the vasa deferentia to open up. Accordingly, I took some action:
1. I took some Chinese pills, Jin Gui Shen Qi Wan, that in the past seemed to help unclog things. These Chinese patent medicines seem really harmless and I had a couple bottles on hand, so why not try them once again?
2. I went to a good public hot tub ("hydrotherapy pool") that is really hot (about 104 degrees Fahrenheit) and has strong jets. I spent a long time in the hot tub, along with some swimming. It seems like directing the hot water jet anyplace on my private parts or suprapubic area has some chance of massaging the little vasa deferentia.
3. I found some new pornography on the web featuring beautiful young women in the Czech Republic (I think. Non-English speakers.).
4. After the first visit to the hydrotherapy pool, something was slightly unclogged, it didn't seem decisive.
5. After the second trip to the hot tub, and jerking off with the nice porn, bingo, something really opened up. A bunch of yellowish pus came out. Since that time my ejaculate volume is much greater, and the fluid appears increasingly normal. I have a feeling that pressure is relieved in places where, even after years of treatment, some structures, in particular the vasa deferentia, were pressurized with archival pus.
6. I still have symptoms:
a. It has felt like that there may have been other tiny stones in the vasa deferentia that became more able to move, so that there were little sharp twinges in the bladder area.
b. As the inflammation drains through the urethra, it is caustic. This pain still causes frequent urination, but the locus of pain is more distal. Previously it would feel like pain in the bladder, perhaps meaning that inflammatory material was aggravating the ejaculatory ducts, making them pressure-sensitive. Now the pain is sharp, but a little more distal. I am optimistic about this, that it represents a process of draining out inflammatory material that will wind down in a few weeks.
c. All of this process, such as the hot baths or even just a walk that stimulates some movement of stuff, also seems to put inflammatory material (cytokines?) into my blood. This causes a lot of fatigue and headache. I have had waves of fatigue over the 4 weeks since the procedure, right down to Tuesday (yesterday), when I took a morning nap and an afternoon nap. Whoa! While various physicians were trying to shrug off my problems, all these structures were full of the most toxic, terrible stuff. This has been a systemic illness for 40 years, an awful systemic illness, plus crippling local pain. Past experiences are put in perspective now that the symptoms are more localized in time and space.
d. It sounds like I am still quite sick, which is true. At the same time, I am doing much better in the past year or so than before that. I have done some very interesting scientific work. I have published good new stuff already, but I hope to do even more work of lasting importance, which will show what I could have done over the years if I had not been so sick. (There were other issues such as stupid bosses, but the illness seems to be a central issue.)
e. To repeat, it has only been during 2004 March that the last (hopefully) clogged structures have gotten unclogged. I still have symptoms that are inconvenient, but there is a distinct feeling that there is a process in which the evil stuff is now draining out and I should feel better from one week to the next, with possibly true health as the endpoint.
f. It is conceivable that I may have to take more antibiotics, but I am not convinced of that. I took a ton of antibiotics in 1996 to 1999, and while I had a strong constitution in the beginning, I felt really hurt by so many drugs in the end. Now my favorite drugs are things like tea and apple juice and vitamins, which feel like strong drugs. The tea is really good for turning off the burning in my urethra that is evoked by the inflammatory material. I never had epididymitis, so I am not sure that the vasa deferentia were infected, though they were quite obstructed.