Outcomes of partial intussusception and endo-to-side vasoepididymostomy in men with epididymal obstructive azoospermia.

Abstract

Vasoepididymostomy is an ideal surgical approach for epididymal obstructive azoospermia. The aim of the present study was to compare reproductive outcomes of vasoepididymostomy with several anastomotic techniques, including end-to-side and longitudinal intussusception vasoepididymostomy, and partial intussusception and endo-to-side vasoepididymostomy. A case-control study including 110 infertile men with epididymal obstructive azoospermia with mean age of 35years was carried out. Univariate and multivariate analyses using clinical factors were carried out to predict patency and non-assisted reproductive technology pregnancy. Johnsen score count and proliferating cell nuclear antigen expression were used as surrogates for spermatogenic function. Operative time, number of 10-0 sutures and late failure rates were also compared. The overall patency and non-assisted reproductive technology pregnancy rates were 70% and 32%, respectively. Multivariate analyses showed that the presence of motile sperm in the epididymis and a higher spermatogenic function (P<0.05) were independent predictors for patency, and that a higher spermatogenic function and anastomosis at the caput/corpus (P<0.001) were predictors for non-assisted reproductive technology pregnancy. The operative time was significantly shorter with partial intussusception and endo-to-side than with the other techniques (P<0.001), and the number of 10-0 sutures was significantly less with partial intussusception and endo-to-side than with longitudinal intussusception vasoepididymostomy (P<0.01). Partial intussusception and endo-to-side as well as end-to-side and longitudinal intussusception vasoepididymostomy are feasible vasoepididymostomy techniques for epididymal obstruction. Spermatogenic function plays important roles in patency and non-assisted reproductive technology pregnancy after vasoepididymostomy. Depending on the surgeon's expertise, partial intussusception and endo-to-side provides similar functional outcomes to those of more established vasoepididymostomy techniques, such as end-to-side and longitudinal intussusception vasoepididymostomy, and it could therefore be considered an effective technique for seminal reconstruction in patients with epididymal obstructive azoospermia.