Clinical experience of epididymovasostomy and vasovasostomy for obstructive azoospermia
Mastuda, T.; Nishimura, K.; Nomomura, M.; Okada, K.; Yoshida, O.; Sanada, S.; Takahashi, Y.
Nihon Funin Gakkai Zasshi 32(3): 352-358
1987
ISSN/ISBN: 0029-0629 PMID: 12158557 Document Number: 357882
Fourteen patients with obstructive azoospermia were treated with microsurgical vasovasotomy or epididymovasostomy. Six cases after bilateral vasectomy, and 5 cases with bilateral vasal disruption by inguinal herniorrhaphy, underwent two-layer vasovasostomy. Three cases after bilateral epididymitis underwent end-to-end epididymovasostomy with Silber's specific tubule technique. After the operation, fertility was restored in 6 out of the 14 cases. They recovered sperm density more than 20 .times. 106/ml and sperm motility more than 50 per cent. Pregnancy was gained in 1 case after inguinal herniorrhaphy. Preoperative testicular biopsies carried in 11 cases disclosed slight deterioration of spermatogenesis. Johnsen's mean score was 8.20 .+-. 0.38 (mean .+-. S.D.). The mean scores of the biopsies obtained from the cases obstructed for more than 20 years were significantly lower than those with less than 20-year-obstruction. After inguinal herniorrhaphy, reanastomosis of vasa deferens was difficult to restore the fertility, because of the long-term obstruction for more than 20 years, the defect of vasa deferens in the inguinal canal in some cases, and the absence of sperm granuloma at the vasectomy sites. Epididymovasostomy restored fertility in 67 per cent of the cases. The specific tubule technique was likely the most effective at present in the management of such pathological conditions.