TRUS-guided needle drainage of a prostatic cyst for treatment of male infertility

Male infertility is a common complaint encountered on an outpatient basis in urology. The initial evaluation and diagnosis of an infertile patient requires a stepwise approach beginning with a thorough history and physical. Infertility can be multifactorial, with many underlying pathologies. One such etiology of infertility is any defect in sperm transport from the testes to the end of the male reproductive tract; this would include a mechanical obstruction such as a prostatic cyst. Case presentation A 28 year old Caucasian male was referred to urology for evaluation of primary infertility. He presented with his wife after being unable to conceive for approximately 1 year with unprotected intercourse. The patient's primary care provider performed an initial semen analysis which revealed low volume ejaculate and virtual azoospermia. Subsequent laboratory analysis included complete blood with differential, complete metabolic panel, serum estradiol, follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, thyroid stimulating hormone, and dehydroepiandrosterone sulfate. Pertinent findings from this workup included a normal follicle stimulating hormone, luteinizing hormone, prolactin, and thyroid stimulating hormone. However, serum testosterone was found to be low at 214.1 ng/mL for which the patient began clomiphene therapy that was titrated to 50 mg in order to normalize serum testosterone levels to 614.8 ng/dL. Repeat semen analysis one month later demonstrated similar findings of low ejaculate volume and virtual azoospermia. On his initial presentation to urology, the patient presented with the aforementioned findings and otherwise had no urogenital complaints. The patient also had an unremarkable past medical history, past surgical history, and family history. The patient endorsed a smoking history and socially drank alcohol. On physical exam, the patient was noted to have a normal genitourinary exam with an orthotopic meatus and no palpable scrotal masses or varicoceles. Retrograde ejaculation analysis was completed 4 weeks following urologic consultation and demonstrated virtual azoospermia with no sperm found on urinalysis. The patient subsequently underwent transrectal ultrasound of the prostate and seminal vesicles one week later which revealed a 2 × 2.3 × 3.0 cm midline prostatic cyst and bilateral seminal vesicle dilation (see Fig. 1). Open in a separate window Fig. 1 Ultrasound images of prostatic cyst.