Diagnosis and surgical treatment of obstructive azoospermia due to iatrogenic vas duct injury

Abstract

Objective The goal of this study was to analyze the diagnosis of azoospermia caused by iatrogenic vas duct injury and evaluate the outcomes of surgical treatment. Methods Eleven patients, whose age ranged from 23 to 37 years old (mean 27 years old), with azoospermia caused by iatrogenic vas duct injury were consecutively admitted in our single center between January 2010 and June 2014. The characters of those patients included 9 cases of bilateral vas duct injury, 2 cases of unilateral vas duct injury with contralateral cryptorchidism or orchiectomy. All patients accepted scrotal physical examination, semen analysis, seminal plasma test, seminal duct Doppler ultrasonography, serum sex hormone and then diagnosed as obstructive azoospermia. Except one patient with unilateral cryptorchidism had normal seminal nutral α-glucosidase, other 10 patients had significantly low nutral α-glucosidase, ranged from 2.4 to 7.4 mU/once ejaculate (mean 4.4 mU/ ejaculation). All patients accept the inguinal surgical exploration. The early 4 patients were unable to be treated with surgical reconstruction due to the large defect of vas duct, failure to find distal vasal stump and secondary epididymal obstruction. Meanwhile, laparoscopic equipments and microscopic techniques were not prepared preoperatively. In the late 7 cases, six underwent simple vasovasostomy, laparoscopic-assisted vasovasostomy, and modified vasoepididymostomy based on length and sites of vasal injuries and condition of secondary epididymal obstruction. One failed to be reconstructed due to pelvic vas atrophy. The definition of successful recanalization was the density of sperm more than 1×106/ml during the postoperative follow-up. Results All patients had iatrogenic vas duct injury. Among six treated patients, five patients achieved recanalization, except one case was still azoospermia. The duration of follow-up in those five patients ranged from 6 to 32 months (mean 18 months). During following-up, naturally achieved pregnancy was recorded in two couples. The others could be treated with assisted reproductive technology, such as ICSI. Conclusion Low seminal nutral α-glucosidase potentially indicates vas duct injury. Surgical reconstruction should be considered as the first choice for azoospermia caused by iatrogenic vas duct injury due to its favorable outcome. Laparoscopic equipment and microsurgical technique can play a crucial role in surgical repair of vas duct injury. Key words: Male infertility, Azoospermia; Iatrogenic injury; Laparoscopy; Microsurgery