Ejaculatory duct obstruction is one of the few causes of azoospermia that can be surgically corrected. Transurethral ejaculatory vasectomy or vesicoscopy is a new approach to treating obstructive azoospermia and is a boon for patients with obstructive azoospermia to have their own healthy babies. With the development of non-invasive examination techniques such as seminal plasma biochemical testing and transrectal prostatic seminal vesicle ultrasound (TRUS), more and more patients with ejaculatory ductal obstructive azoospermia have been diagnosed clinically, and the development of minimally invasive surgical techniques in the last decade has made its treatment possible. When the volume of semen is less than 2 milliliters, the semen has no spermatozoa, the pH is low, the seminal plasma fructose is 0 or very low, the discharged semen is not coagulated and the testicular biopsy is normal, consider ejaculatory duct obstruction. First, the etiology of ejaculatory duct obstruction is mainly due to the following three aspects: 1, congenital developmental anomalies: cystic changes in the prostate account for the majority of congenital anomalies, such as Müllerian duct cysts and Wolffian duct cysts; in addition, there are congenital vas deferens, ejaculatory ducts, seminal vesicles are missing; 2, genitourinary infections: such as prostatitis, prostatic abscesses, cystitis and posterior urethritis. 3, medical injury: such as long-term indwelling catheter, transurethral prostate surgery after ejaculatory duct scar formation, prostate surgery, pelvic and rectal surgery. II Clinical manifestations This disease mostly occurs in young adults, in addition to infertility, can be completely asymptomatic. Some patients have pain in the prostate area after ejaculation and ejaculation, which radiates to the scrotum, hematospermia, sudden decrease in semen volume, difficulty in bowel movement and a feeling of urgency and heaviness. Third, diagnosis The diagnosis of ejaculatory duct obstruction mainly includes urogenital history and physical examination, plasma testosterone measurement, semen analysis. Clinical transrectal ultrasonography is meaningful in clarifying whether the ejaculatory duct is occluded and its location. 1, semen analysis: semen volume <2 ml, bilateral ejaculatory duct complete obstruction semen volume less than 1 ml, containing only prostatic fluid, semen non-frozen gelatinous coagulation state was watery, low ph value was acidic. Patients with incomplete obstruction of the ejaculatory duct may have normal or reduced semen volume, the main manifestations are low semen volume (<1.5ml), low sperm viability (<30%), low sperm count (<20×106 spermatozoa/ml) and increased percentage of abnormal spermatozoa, which should be paid attention to in the clinical work, and it is often prone to leakage or misdiagnosis. 2, Post-coital urine sediment analysis, except retrograde ejaculation. 3, serum testosterone measurement: the general public serum testosterone level is normal. Low serum testosterone levels and low semen volume are rarely caused by ejaculatory duct obstruction. However, in the testis and serum testosterone level is normal, infertile patients after varicocele vein ligation semen parameters did not change, semen volume is still low, sperm viability is poor, sperm less should be considered the existence of ejaculatory ductal part of the obstruction. 4, imaging: the site and degree of ejaculatory duct obstruction can be determined by high-resolution transrectal ultrasonography (TRUS), vasography and transrectal vesicoureteral aspiration plus contrast. turek et al. TRUS diagnostic criteria for ejaculatory duct obstruction are: ① vesicoureteral dilatation > 1.5cm; ② ejaculatory duct dilatation diameter > 2.3mm ③ caruncle or ejaculatory duct calcium stone formation; ④ The presence of cysts near or away from the midline of the caruncle may indicate a Müllerian duct cyst or a Wolffian duct cyst. (Diagnosis can be established if one of the above four items is present. Indications for surgery] This surgery is suitable for azoospermia caused by ejaculatory duct obstruction with fertility requirements. However, it is contraindicated in cases of acute and chronic inflammation and tuberculosis, and cannot be performed in cases of ejaculatory duct obstruction combined with long-segment vas deferens obstruction. Absolute indications: (1) ejaculatory duct obstruction typical “four low” semen characteristics, that is, semen volume is reduced, the more severe the degree of obstruction, the lower the semen volume; oligozoospermia, bilateral complete obstruction of the patient, for the absence of spermatozoa; semen pH is reduced to be acidic; seminal plasma fructose level is reduced or even 0; and there are the typical TRUS image mentioned above. characteristics. (2) Pain in the region of the prostate after ejaculation and ejaculation, with hematospermia, and with the typical TRUS picture features described above. Relative indications: (1) Male infertile patients with reduced semen volume, sperm density <20×106/ml, and typical TRUS image features as described above. (2) Male infertile patients with reduced semen volume and <30% motile spermatozoa, with typical TRUS image features as described above. Lesions (obstruction, calcification, stones or cysts) within 1.0~1.5cm from the seminal surface of the seminal vesicle are suitable for TURED, and ejaculatory duct stones or cystic lesions are especially suitable for TURED. Advantages of the surgery: The surgery is less damaging, no wounds, shorter hospitalization time (4~5 days), obvious results, low cost, and fewer side effects.