Is physical examination useful in predicting epididymal obstruction?

Abstract

Objectives. To evaluate the independent predictive value of subjective epididymal fullness in predicting obstruction in azoospermic men (group 1) and determining preoperatively the need for vasoepididymostomy (VE) in men presenting for vasectomy reversal (group 2). Methods. All men were evaluated with a medical history and physical examination. During the physical examination, the epididymis was classified as full, if any portion was palpably distended, or normal. Obstruction was confirmed at surgical exploration for group 1 after a biopsy that revealed sufficient spermatogenesis. In group 2, the indications for VE were either no fluid seen from the testicular end of the vas or thick, pasty fluid devoid of sperm. In cases in which VE was required, these units were classified as obstructed. Results. The predictive value of epididymal fullness was evaluated in 51 units (12 in group 1 and 39 in group 2). The sensitivity, specificity, and positive and negative predictive values were 67%, 100%, 100%, and 83%, respectively, in group 1 and 33%, 89%, 20%, and 94%, respectively, in group 2. Conclusions. Epididymal fullness in azoospermic men is predictive of obstruction, although a normal epididymal examination cannot rule out obstruction. In men presenting for vasectomy reversal, the absence of epididymal fullness is predictive of vasal fluid that allows for vasovasostomy. Epididymal fullness may suggest, but cannot predict, unfavorable vasal fluid that requires VE.