Diagnosis of acquired obstructive azoospermia and surgical treatment outcome analysis

Abstract

Objective To study the diagnosis of acquired obstructive azoospermia and analyse the outcomes of surgical treatment. Methods One hundred and six patients were diagnosed with acquired obstructive azoospermia at our center between January 2009 and May 2014.A total of 106 patients aged from 22 to 46 years (mean age: 30 years old), their duration of infertility were 2 to 16 years, mean 3 years. All patients had clinic findings related to azoospermia, including no sperm found in semen analyses and centrifuged semen sample, normal scrotal ultrasonogram and serum sex hormone, 71 cases with a history of natural conception or normal semen analyses, 35 cases with a normal level of spermatogenesis confirmed by testicular biopsy. Physical examination and ultrasonography of the genital system shown that the seminal duct were normally developed in all patients. One hundred and six patients with acquired obstruction were treated by multiple surgical techniques and follwed–up. Of them, 15 surgical explorations and 91 reconstructions, including 11 transurethral incision of ejaculatory duct with holmium laser, 6 microscopic vasovasostomy at inguinal region, 10 microscopic vasovasostomy, 47 modified transverse intussusception vasoepididymostomy and 17 combined surgical techniques. Patency was defined as >10 000 sperm/ ml of semen. Results The postoperative follow–up time was 12 months to 52 months. Eighty two had return of sperm to ejaculate and nine failed, the overall patency rate was 90.1% (82/91). The patency rate was 90.9%(10/11)、83.3%(5/6)、100.0%(10/10)、89.4%(42/47)、88.2%(15/17)for transurethral incision of ejaculatory duct with holmium laser, microscopic vasovasostomy at inguinal region, microscopic vasovasostomy, modified transverse intussusception vasoepididymostomy and combined surgical techniques, respectively. Thirty two patients naturally achieved conception. Postoperative complications included one case of fever, one hemospermia and one delayed wound healing at scrotum, all were cured by medication. No severe complication were observed. Conclusion Azoospermia with normal testicular spermatogenesis and normally developed seminal duct was classified as acquired obstructive azoospermia. Surgical treatment for acquired obstruction have a favorable patency and pregnancy rate. Key words: Azoospermia; Diagnosis; Surgical treatment