Microsurgical Correction of Posttesticular Obstruction

Abstract

Exploration for microsurgical reconstruction of the vas deferens or its epididymal junction was performed in 47 consecutively treated men. Epididymovasostomy was planned in 27 cases. Malformation was found in five and Young's syndrome in nine, and most of the others had a history of urogenital infections. Reconstruction was accomplished in 17 cases. Nine were azoospermic preoperatively. Four (three with Young's syndrome/malformation) remained so, whereas patency was demonstrated in four and one did not supply a semen specimen postoperatively. Eight had severe unexplained oligozoospermia preoperatively, and in four of them the sperm counts normalized postoperatively while the other four remained oligozoospermic. In no case did preoperative oligozoospermia progress to azoospermia postoperatively. Complete normalization of all spermiogram parameters occurred in only two cases after epididymovasostomy. Of the 20 who underwent reversal of vasectomy, 17 provided semen for postoperative testing. 16/17 specimens contained spermatozoa, but spermiograms, including penetration tests, were completely normal in only three cases. This study indicates a discrepancy between good patency and good semen quality. Our study also suggests that some men with unexplained severe oligozoospermia are as likely to benefit from epididymovasostomy as are azoospermic men.