Prognostic Factors in the Surgical Treatment of Azoospermia

Abstract

Surgery for male obstructive infertility is not always successful. A number of clinical and operative findings, not previously reported, may influence the outcome. We have studied 182 patients with azoospermia who underwent vasoepididymostomy. The pre-operative and operative findings which adversely affected the function of the anastomosis were identified. The presence of spermatozoa in the semen sample was taken to mean a successful anastomosis. Abnormal testicular histology was an adverse pre-operative finding. Adverse operative findings included non-canalisation of the epididymal tubules and hypoplasia of the epididymis; both factors were associated with a high failure rate (almost 100%). The anastomosis was a failure in 78% of the patients when no fluid was seen on sectioning the epididymis. In the absence of adverse findings the success rate of vasoepididymostomy was 59%. Pre-operative testicular biopsy, together with careful observation and recording of findings before and during surgery, are recommended to avoid needless exploration and anastomosis.

Repeat epididymovasostomies: are they worthwhile?

“…Antisperm antibodies did not preclude a favourable outcome and three of nine men who had antisperm antibodies achieved pregnancies after steroid therapy. Kapur et al [ 17] examined factors predictive of outcome in epididymovasostomy and concluded that abnormal testicular histology, epididymal hypoplasia and absence of epididymal fluid at exploration were independent negative predictors of success. However, Niederberger and Ross [ 18] suggested that the presence or absence of sperm in the epididymal fluid at the time of microsurgical epididymovasostomy was the most important single predictor of outcome.…”

Surgery for azoospermia in the Indian patient: Why is it different?

“…[23] Kapur et al . [24] in 1989 reported their results of vasoepididymostomy and found a patency rate of 59% in the absence of adverse factors such as abnormal histology, absence of fluid in the epididymis or hypoplastic epididymis. We have recently reported our modifications and outcomes with both the standard two-suture and longitudinal two-suture techniques of VEA in men with idiopathic vaso-epididymal obstruction.…”