Transrectal ultrasound (TRUS) provides high-resolution imaging of the prostate, seminal vesicles and vas deferens.
It is the modality of choice in diagnosing congenital and acquired abnormalities causing obstructive azoospermia (OA).
semen analysis findings of such patients is consistent with complete distal ejaculatory obstruction, including low ejaculate volume (usually less than 1.5 ml), azoospermia, low pH (less than7), and absence of fructose.
TRUS can be performed as an outpatient procedure without the need for anesthesia.
The patient is positioned in a left lateral decubitus position. A high-frequency endorectal transducer should be used with a condom cover. Systematic evaluation of the terminal vas deferens, seminal vesicles, ejaculatory duct and prostate are carried out in axial and sagittal planes
TRUS is also used to guide prostatic cyst aspiration.
The types of pathologies found on a TRUS evaluation include agenesis or hypoplasia of urogenital structures, cysts, dilatations, calcifications, and stones. Distal ejaculatory duct obstruction (EDO) is strongly suspected in case of azoospermia in which TRUS reveals dilated seminal vesicles with an anteroposterior length greater than 15 mm, or ejaculatory ducts with diameter greater than 2.3 mm. In these men sperms can be acquired from testis and can plan icsi procedure for fertility