Distal Male Genital Tract Abnormalities Detected by Transrectal Ultrasonography Screening in a Group of Low Semen Volume Infertile Men

Introduction: The exact prevalence of small ejaculate volume among infertile men is still unknown and the frequency of its etiological causes has not yet been well defined in the literature. TRUS is the most commonly used screening test to detect different causes of distal male genital tract abnormalities.Objective: To detect distal male genital tract abnormalities by TRUS screening of infertile men with low semen volume.Patients and Methods: This cross sectional prospective study included 59 low semen volume infertile men, 37 azoospermic (AZ) and 22 oligo/asthenozoospermic (OAZ). Seminal fructose, FSH and total testosterone were estimated and expressed prostatic secretion and post-ejaculatory urine analyses were done for each participant. All participants were screened by TRUS.Results: TRUS screening detected findings suggestive of ejaculatory duct obstruction (EDO) in 17 (28.8%) patients (9 AZ and 8 OAZ), vasal aplasia (VA) in 10 (16.9%) patients (9 AZ and 1 OAZ), chronic prostatovesiculitis (CPV) in 9 (15.3%) patients (6 AZ and 3 OAZ), hypoplasia of prostate and seminal vesicles in 3 (all AZ) and retrograde ejaculation in 2, one from each group. TRUS criteria suggestive of obstructive etiology were found in 48.6% and 40.9% in the AZ and OAZ groups respectively. Normal TRUS findings were found in 18 (30.5%) of the total, 9 (24.3%) AZ and 9 (40.8%) OAZ.Conclusion: Distal male genital tract abnormalities, especially the obstructive ones, are common in low semen volume infertile men. EDO was the most common abnormality detected followed by VA then CPV. When TRUS combined with other clinical and laboratory findings, it is a good screening test to detect distal male genital tract abnormalities.