Impact of Epididymal Sperm Aspiration on Microsurgical Vasoepididymostomy Outcomes in Patients with Obstructive Azoospermia-Report of 21 Cases Attached

Abstract

Background: To explore the impact of epididymal sperm aspiration on microsurgical vasoepididymostomy (MVE) outcomes in patients with obstructive azoospermia (OA). Methods: A retrospective analysis was conducted on 21 patients with OA who underwent epididymal sperm aspiration and received treatment at the department of andrology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from September 2016 to March 2023. Under microscopic scrutiny, the structure of the epididymis and any injuries to its ducts were observed and compared during MVE. Results: Microscopic analysis of 21 patients revealed notable changes in the appearance of the epididymis, showcasing substantial scar contracture and evident adhesion between the epididymal fascia and tunica vaginalis within the sheath, posing challenges in their separation. Among them, 12 patients exhibited fractured, shrunk, fibrotic, and semen-devoid epididymal ducts. Consequently, MVE could not be completed in 15 patients because of these factors, and only six patients underwent MVE. Among the patients who successfully underwent MVE, three patients had sperm in the follow-up examination 3 months after surgery, accounting for 50%. Conclusion: Epididymal sperm aspiration can damage the normal structure of the epididymis and epididymal duct, often leading to surgical termination during operation and a decrease in the long-term patency rate following surgery. Therefore, patients with OA are recommended to undergo MVE as the initial procedure. In case the surgery prove unsuccessful, epididymal or testicular sperm aspiration can be performed for intracytoplasmic sperm injection (ICSI) assisted reproduction. Additionally, patients with OA are advised to avoid diagnostic epididymal sperm aspiration.