Surgical treatment for epididymal obstructive azoospermia

Abstract

Objective To discuss the clinical outcomes of surgical treatment on epididymal obstructive azoospermia （EOA） and the factors affecting clinical results. Methods The clinical data of 51 EOA patients who underwent single layer longitudinal 2-suture intussusception vasoepididymostomy （LIVE） were retrospectively analyzed. The months of follow up, mean level of sperm count per ejaculate and percentage of grade A sperm were collected. Patency and pregnancy rates were recorded during followups. Results A total of 51 men were taken scrotal exploration. Sperms were bilaterally or unilaterally present in epididymal fluid in 49 cases, including 1 case had sperm in one side of the epididymal fluid and the contralateral vasal fluid. No sperm was found in epididymis in 2 cases. Bilateral and unilateral LIVE were performed in 48 cases. 44 were followed for more than 6 months and 39 for more than 1 year. Sperm was present in ejaculate in 32 of cases, the overall patency rates were 72.7%. The mean sperm count was （24±23） × 10^6 per ejaculate. Grade A sperm was present in the ejaculate in 28 cases with a mean levels of （12± 11.2）%. A total of 10 cases achieved pregnancy.Pregnancy was achieved only when the site of anastomosis was at cauda epididymis. Conclusions Loupe-assisted LIVE, with lower cost and simplified surgical procedure, could achieve optimistic patency outcomes and pregnancy results. Data of this paper also suggested that it should be taken into account that pregnant outcome was related to the site of anastomosis. Key words: Obstructive azoospermia; Intussusception; Vasoepididymostomy