TURED — Transurethral Resection of the Ejaculatory Ducts

TURED stands for Transurethral Resection of the Ejaculatory Ducts.

It is an endoscopic urological procedure used to treat ejaculatory duct obstruction.

The ejaculatory ducts pass through the prostate and carry sperm-containing fluid from the vas deferens and seminal vesicles into the urethra.

When one or both ducts are blocked, sperm and seminal fluid may not enter the ejaculate normally.

TURED removes or opens the obstructing tissue from inside the urethra.

Why can ejaculatory duct obstruction cause infertility?

The seminal vesicles contribute a large portion of normal semen volume.

When both ejaculatory ducts are completely obstructed, typical semen findings may include:

• Low semen volume

• Azoospermia

• Acidic semen

Partial obstruction may instead cause:

• Severe oligozoospermia

• Poor sperm motility

• Reduced semen volume

• Painful ejaculation

• Haematospermia

The testes may still produce sperm normally.

The problem is that sperm cannot reach the ejaculate.

How is TURED performed?

The surgeon inserts a resectoscope or similar endoscopic instrument through the urethra.

No external skin incision is usually required.

The surgeon advances the instrument to the prostatic urethra, where the ejaculatory ducts open.

Obstructing tissue is then carefully incised or resected.

Depending on the cause, the operation may address:

• Scar tissue

• Midline cysts

• Ductal obstruction

• Calcification

• Other obstructing lesions

The goal is to create a functional opening so seminal-vesicle and sperm-containing fluid can drain into the urethra.

How is the obstruction located?

Diagnosis and surgical planning may use:

• Semen analysis

• Semen pH

• Transrectal ultrasound

• Pelvic MRI in selected cases

• Seminal vesicle findings

• Prostatic cyst identification

TRUS is particularly useful when low semen volume, acidic semen and severe oligozoospermia or azoospermia suggest distal obstruction.

What causes ejaculatory duct obstruction?

Potential causes include:

• Congenital duct abnormalities

• Midline prostatic cyst

• Müllerian duct cyst

• Prostatic utricle cyst

• Ejaculatory duct cyst

• Infection

• Inflammation

• Scarring

• Calcification

• Stones

• Previous prostate procedures

Some men have no clearly identifiable cause.

Complete vs partial obstruction

TURED can be used in selected men with either complete or partial obstruction.

Complete obstruction

Both ducts are fully blocked.

The patient may have:

• Azoospermia

• Very low semen volume

• Acidic semen

Partial obstruction

Some seminal fluid and sperm still pass.

The patient may have:

• Severe oligozoospermia

• Poor motility

• Reduced semen volume

• Painful ejaculation

• Haematospermia

The clinical benefit of surgery depends partly on the type and severity of obstruction.

Does TURED restore natural fertility?

Potentially, yes.

Unlike sperm retrieval procedures such as PESA, MESA or TESE, TURED attempts to restore natural passage of sperm into the semen.

If sperm return in adequate numbers and female fertility is favorable, natural conception may become possible.

However, some couples may still require assisted reproduction after surgery.

How soon can semen improve?

Changes in semen parameters may become apparent over several weeks to months.

Semen analyses are therefore repeated after surgery.

The fertility team may track:

• Semen volume

• Sperm concentration

• Motility

• Total motile sperm count

Improvement can continue over time.

What if sperm do not return?

If azoospermia persists after TURED, possible explanations include:

• Incomplete relief of obstruction

• Recurrent scarring

• Additional reproductive-tract obstruction

• Coexisting impaired sperm production

The patient may then require further evaluation or sperm retrieval with IVF/ICSI.

TURED vs sperm retrieval

These are different treatment strategies.

TURED attempts to restore sperm to the natural ejaculate.

Sperm retrieval bypasses the obstruction and obtains sperm directly from the epididymis or testicle.

TURED may be attractive when natural conception is a realistic goal and anatomy is suitable for correction.

Sperm retrieval with ICSI may be more appropriate when:

• Female partner age is advanced

• Ovarian reserve is reduced

• IVF is already required

• Distal reconstruction is unlikely to succeed

• Faster assisted reproduction is preferred

Why surgeon experience matters

The ejaculatory ducts are small structures located close to:

• Prostate

• Urethra

• Bladder neck

• Seminal vesicles

Overly aggressive resection can create complications.

The procedure should therefore be performed by a urologist experienced in male infertility and endoscopic reproductive surgery.