Mullerian duct cyst: a curable entity of male infertility. Two case reports
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CASE REPORT
Mullerian duct cyst: a curable entity of male infertility. Two case reports Yoshitomo Kobori • Ryo Sato • Yoshio Ashizawa Hiroshi Yagi • Shigehiro So • Gaku Arai • Hiroshi Okada • Takashi Okuyama
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Received: 28 September 2009 / Accepted: 23 July 2010 / Published online: 28 September 2010 Ó Japan Society for Reproductive Medicine 2010
Abstract Purpose Mullerian duct cyst is a rudiment of a Mullerian duct in the fetal period which causes ejaculatory duct obstruction and male infertility. Case report We report two patients with Mullerian duct cyst that presented with low ejaculate volume, oligoasthenoteratozoospermia and azoospermia syndrome. Transrectal ultrasound (TRUS) and magnetic resonance image (MRI) revealed a midline prostatic cystic structure. In each case, we performed a TRUS guided transperineal aspiration of the cyst. Seminograms of the patients improved and one of their wives got spontaneously pregnant 3 months after the surgery. Conclusion We should assume the TRUS guided aspiration of Mullerian duct cyst. Keywords
Mullerian duct cyst Male infertility
Introduction Ejaculatory duct obstruction is reported to be the cause of azoospermia in up to 5% of patients [1]. Mullerian duct cysts reportedly cause ejaculatory duct obstruction, severe
Y. Kobori (&) R. Sato Y. Ashizawa H. Yagi S. So G. Arai H. Okada Department of Urology, Koshigaya Hospital, Dokkyo Medical University, 2-1-50, Minamikoshigaya, Koshigaya 343-8555, Japan e-mail: [email protected] T. Okuyama Department of Surgery, Koshigaya Hospital, Dokkyo Medical University, Koshigaya, Japan
oligozoospermia and motility disorder [2]. We report two cases of oligoasthenozoospermic and azoospermic patients, each with a Mullerian duct cyst whose seminogram normalized after TRUS guided aspiration.
Case report Case 1 A 31-year-old male visited our male infertility clinic with a chief complaint of infertility. Physical examinations were unremarkable and endocrinologic tests (serum levels of testosterone, follicle-stimulating hormone and luteinizing hormone) indicated no abnormalities; however, semen analyses showed low ejaculate volume and few motile spermatozoa (a semen volume of 0.4–1.0 ml, sperm concentration of 0–10 9 106/ml, sperm motility of 0–1%). TRUS and MRI revealed a midline cystic mass which was diagnosed as Mullerian duct cyst (Fig. 1). We performed transperineal TRUS guided aspiration of the cyst under local anesthesia (Fig. 2). The aspirated liquid was yellowish and serous, and contained no sperm. Postoperative semen analysis showed improvement of seminograms: semen volume of 1.4 ml, sperm concentration of 78 9 106/ml, sperm motility of 67%. Spontaneous pregnancy of his spouse was confirmed 3 months after the surgery. Case 2 A 35-year-old male visited our clinic with a chief complaint of obstructive azoospermia. His semen volume was very low (0.5–1.0 ml). He was diagnosed with Mullerian duct cyst by the TRUS and underwent MRI examination. He was treated by transperineal TRUS-guided aspiration therapy. He had
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