Obstructive Interval Research Articles

Does Epididymal Induration Predict the Need for Epididymovasostomy at Vasectomy Reversal?

Objective: Very few clinical parameters correlate well with the need to perform epididymovasostomy (EV) during vasectomy reversal procedures. In addition to the time interval from vasectomy to reversal, the presence of a sperm granuloma is helpful in counseling patients in this regard. We assess whether the presence of dilated epididymides on physical examination can further inform surgeons on this issue. Design: Case controlled retrospective analysis of a consecutive series of patients. Materials and Methods: From the last 80 patients who underwent vasectomy reversal by a single surgeon data on the presence or absence of epididymal induration was recorded on individual testicular units. Epididymal induration was defined as an enlarged or tense (but not necessarily tender) epididymis. This information was correlated to the type of reversal procedure performed and the intraoperative findings. EV’s were performed in the absence of sperm at the testicular vas deferens. Unpaired t tests were used for statistical comparisons. Results: Findings are given in the table below: Tabled 1Epididymal induration (+)Epididymal induration (−)P valueNumber of patients3545Number of sites53107Mean age (years)44 ± 6.442 ± 5.70.13Mean obstruction interval (years)12.1 ± 6.99.6 ± 5.50.09# Vasovasostomy (% all units)33 (62%)90 (84%)0.004# Epididymovasostomy (% units)20 (38%)17 (16%)0.004 Open table in a new tab Conclusion: Epididymal induration on preoperative exam for vasectomy reversal surgery is associated with a longer obstructive interval after vasectomy. With this finding, the likelihood of EV surgery doubles. This information may supplement other data used in counseling these patients.

Vasectomy reversal.

Vasectomy reversal.

Microsurgical Vasovasostomy versus Microsurgical Epididymal Sperm Aspiration/Testicular Extraction of Sperm Combined with Intracytoplasmic Sperm Injection

Purpose: Vasovasostomy (VVS) represents the standard therapy of choice for the treatment of obstructive azoospermia following vasectomy. However, recently, intracytoplasmic sperm injection (ICSI) has been suggested by some to represent the solution for all cases of malefactor infertility regardless of its etiology based on its success rates. Therefore, we compared VVS to microsurgical epididymal sperm aspiration (MESA)/testicular extraction of sperm (TESE) and ICSI in terms of pregnancy, complications, and costs.Patients and Methods: Between 1/93 and 6/98, 157 VVS were performed microsurgically using the double–layer technique. Between 9/94 and 9/97, 69 and 42 couples underwent MESA/ICSI and TESE/ICSI, respectively, for epididymal obstruction and azoospermia of testicular origin. Results: The mean interval of vasal obstruction was 7.6 (0.5–18) years; patency after VVS was 77%, pregnancy rate was 52%. Local complication rate was 4.7%, no major complications were observed. Costs per life birth after VVS were 5,447 DM or 2,793 Euro. Pregnancy rates after MESA/TESE and ICSI were 22.5 and 19.5%, respectively, with 16 singletons, 3 twins and 3 abortions; local complications occurred in 3.9% of the men. Multiple births were noticed in 15.8% following ICSI, but in only 0.7% following VVS. 5.7 and 1.4% of the female partners experienced serious complications (mild or severe ovarian hyperstimulation syndrome, respectively). Costs per life birth after a MESA/TESE cycle amounted to 28,804 DM or 14,547 Euro.Conclusions: Even in the era of ICSI, microsurgical VVS represents the standard approach for obstructive azoospermia following vasectomy. Based on a cost–benefit analysis, VVS is more successful in terms of pregnancy rates (52 vs. 22.5%). VVS does not expose the female partners to complications following treatment of male infertility. In contrast to ICSI, multiple birth rates do not increase after VVS. We conclude that MESA/ICSI should be reversed for patients who are not amenable for microsurgical reconstruction.

REPEAT VASECTOMY REVERSAL AFTER INITIAL FAILURE: OVERALL RESULTS AND PREDICTORS FOR SUCCESS

Purpose We review the treatment outcomes for microsurgical reconstruction following failed vasectomy reversal and identify predictors for success. Materials and Methods We performed a retrospective review of our experience with microsurgical reconstruction in 41 men who underwent 1 or more prior unsuccessful vasectomy reversal procedures. Of these patients 20 underwent bilateral (16) or unilateral (4) vasoepididymostomy, 11 underwent bilateral (7) or unilateral (4) vasovasostomy and 10 underwent unilateral vasoepididymostomy with contralateral vasovasostomy. Postoperative followup consisted of serial semen analyses and telephone interviews. Results Patency and pregnancy followup data were available in 33 and 31 patients, respectively. Five couples had ongoing uncorrected female factor infertility problems and were not included in pregnancy rate calculations. Mean obstructive interval was 10.6 years. Overall patency and pregnancy rates were 79 and 31%, respectively. Mean total motile sperm count for patients demonstrating patency at followup was 38.0 million. History of conception with the current partner was predictive of future conception with 4 of 5 nonremarried couples (80%) initiating a pregnancy versus 3 of 18 remarried couples (17%) (p = 0.006). Other factors, including smoking history and obstructive interval, did not correlate with postoperative success. Reconstruction with vasovasostomy on at least 1 side trended toward improved patency (p = 0.17) and pregnancy rates (p = 0.15), although they did not assume statistical significance. Conclusions Microsurgical reconstruction following failed vasectomy reversal is associated with high patency and moderate pregnancy rates at short-term followup. In our series previous conception with the current partner was predictive of future conception after reconstruction. Urologists performing repeat vasectomy reversal must be familiar with microsurgical techniques, since almost three-quarters of patients will require at least unilateral vasoepididymostomy.

MICROSURGICAL REPAIR OF IATROGENIC INJURY TO THE VAS DEFERENS

Purpose We determined the incidence of iatrogenic injuries to the vas deferens at a tertiary care university infertility center and the results of surgical repair. Materials and Methods Records of 472 patients surgically explored for obstructive azoospermia between 1984 to 1996 were reviewed. Enrollment criteria included history of inguinal, pelvic and scrotal (other than vasectomy) surgery. Conventional ipsilateral and crossover vasovasostomies and vasoepididymostomies were performed. Patency rate was defined as presence of complete sperm with tails in a postoperative semen analysis. Followup included a minimum of 2 semen analyses. Only naturally conceived pregnancies were included. Results Of 472 patients 34 (7.2%) had an iatrogenic injury to the vas deferens with a mean obstruction interval of 20.5 +/− 1.9 years. Mean patient age was 36.7 +/− 1.8 years. Iatrogenic injury to the vas deferens was secondary to bilateral inguinal hernia repair in 19 patients, unilateral hernia repair in 11, renal transplantation in 2, appendectomy in 1 and spermatocelectomy in 1. Pediatric inguinal hernia repair was the most common etiology of the vasal injury (20 patients), followed by adult inguinal hernia repair (10). A total of 36 microsurgical reconstructive procedures were performed, including 20 ipsilateral and 16 crossed vasovasostomies and vasoepididymostomies. There were 26 patients (29 procedures) available for followup (mean 21.0 +/− 3.7 months). Total patency rate per procedure was 65% and pregnancy rate was 39%. Patency and pregnancy rates per conventional ipsilateral procedures were 62.5 and 35.7% and per crossover procedures 64.2 and 42.8%, respectively. Conclusions Pediatric inguinal hernia repair is the most common cause of iatrogenic injury to the vas deferens. Results of treatment of iatrogenic injury to the vas deferens are somewhat lower than for patients with obstructive azoospermia due to vasectomy. Iatrogenic injuries are associated with longer vasal defects, impaired blood supply and longer obstructive intervals frequently resulting in secondary epididymal obstruction. Crossover reconstruction is particularly useful when contralateral testicular atrophy is present. Intraoperatively aspirated sperm should be cryopreserved for later use in case the reconstruction fails.

Vasoepididymostomy for Vasectomy Reversal: A Critical Assessment in the Era of Intracytoplasmic Sperm Injection

Purpose We compared vasoepididymostomy to microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection for treatment of epididymal obstruction secondary to vasectomy. Materials and Methods Results in patients who underwent vasoepididymostomy for vasectomy reversal at our institution were compared to those reported previously for microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection performed for obstructive azoospermia. The pregnancy rates, delivery rates, complications, cost per procedure and cost per delivery were compared. A cost per newborn analysis was performed using pregnancy and delivery rates, and reported cost estimates for the complications of assisted reproductive techniques. Results A total of 55 men underwent 58 vasoepididymostomies in an attempt to restore fertility after vasectomy. Median followup was 19 months (range 0 to 115). Median obstructive interval was 12 years. There were no major complications. The patency rate after 6 months was 85%. Of the couples 20 achieved 24 pregnancies and 16 had 17 live births. The pregnancy rate at 1 year was 44%. There were 4 miscarriages and there are 3 ongoing pregnancies. The live delivery rate was 36%. Assuming a 29% delivery rate for microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection, the cost per newborn was $51,024, compared to $31,099 for vasoepididymostomy. Conclusions Vasoepididymostomy is more successful and more cost-effective than microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection for vasectomy reversal. It does not expose the women to complications in the treatment of a male problem and it is indicated for treatment of epididymal obstruction secondary to vasectomy. Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection should be reserved for cases not amenable to surgical reconstruction.

Effect of level of anastomosis and quality of intraepididymal sperm on the outcome of end-to-side epididymovasostomy

Objectives. Epididymovasostomy is commonly performed at the most distal site of the epididymis where whole sperm are present within the lumen, regardless of their motility status. Although more fresh and motile sperm can be found more proximally within the epididymis, it is believed that the outcome of epididymovasostomy is better more distally. Because the current results of epididymovasostomy are far from perfect, it would be ideal to be able to harvest motile sperm for cryopreservation at the time of surgery in case the patient remains azoospermic postoperatively. The objective of this study was to determine the effect of the level of epididymal anastomosis and quality of sperm on the outcome of surgery. Methods. An end-to-side epididymovasostomy was performed on 131 azoospermic men with a mean age of 39 years and a mean obstructive interval of 18 years. The etiology of obstruction was vasectomy in 48%, infectious in 19%, congenital in 20%, and unknown in 13%. The average duration of follow-up was 32 months. The overall patency rate was 67% and pregnancy rate was 27%. Subgroups of patients with an anastomosis to the same level of the epididymis on all functional sides were identified as follows: caput (56), corpus (28), and cauda (13). These groups were compared in regard to the presence of motile sperm within the epididymal lumen at the time of surgery, patency rates, postoperative semen quality, and pregnancy rates. Results. Motile sperm were present more often in both the caput (54%) and corpus (61%) than in the cauda epididymis (25%) ( P <0.05). The patency rates for the three subgroups were not significantly different. The postoperative total motile sperm count and pregnancy rate for the corpus epididymis (13 × 10 6 and 45%) was significantly ( P <0.05) better than for the caput (4.4 × 10 6 and 22%) but no different than that of the cauda (10 × 10 6 and 23%). The patency and pregnancy rates for anastomoses performed at levels demonstrating motile sperm were not significantly better than at sites with nonmotile sperm, but the postoperative total motile sperm count was better ( P <0.05). Conclusions. The results of this study suggest that the outcomes of epididymovasostomy to the corpus and cauda epididymis are roughly equivalent and superior to the caput. Therefore, it may be reasonable to move more proximally from the cauda to corpus in the search for motile sperm for cryopreservation during an end-to-side epididymovasostomy. In contrast, moving from the corpus to the caput epididymis has a significant adverse effect upon outcome; it is, therefore, not worthwhile to search for viable sperm for cryopreservation in this clinical setting.

Electrovasography in normal and vasectomized men before and after vasectomy reversal.

The electrical pattern of the vas deferens, or electrovasogram (EVG), was studied in 22 healthy volunteers, 20 vasectomy subjects and 18 individuals after vasectomy reversal. Their mean ages were 38.8 +/- 7.3, 44.3 +/- 7.9 and 58.6 +/- 6.6 years, respectively. Two electrodes were applied to the posterior aspect of the upper part of the scrotum. During the operation of vasectomy reversal, an electrode was applied directly to each of the two vasal segments before and immediately after vasovasostomy. The electrical activity and intravasal pressure were measured. In normal subjects, slow waves or pacesetter potentials (PP) were recorded. They had identical frequency and a regular rhythm from the two electrodes and were consistent in the individual subject on all test days. PP were followed randomly by bursts of action potentials (AP). In vasectomized subjects, PP from the proximal vasal segment exhibited an irregular rhythm (vasoarrhythmia). During operation for vasectomy reversal, the proximal vasal segment recorded vasoarrhythmia whereas the distal segment revealed a silent EVG. Intravasal pressure was normal (p > 0.05) in the distal segment but high (p < 0.05) in the proximal segment. EVG performed 1-6 years after vasectomy reversal showed a normal pattern in four subjects and diminished frequency and amplitude in three. These seven subjects had impregnated their wives and had an obstructive interval of < 3 years. The 11 subjects who did not produce a pregnancy had a vasoarrhythmic EVG and an obstructive interval of > 3 years. In conclusion, an EVG could be identified for normal subjects. Vasectomy resulted in a vasoarrhythmic EVG pattern which proved to be correctable by vasectomy reversal if the obstructive interval was short.

Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres.

In this series we present the results of a retrospective analysis of 66 vasovasostomy procedures performed between 1983 and 1991. Obstructive intervals and serum antisperm antibodies were correlated with pregnancy and patency rates. With obstructive intervals of less than 5 years a patency rate of 100% (31/31) was obtained. Even more than 10 years after reversal, pregnancy occurred in 25% (2/8) of the patients. Preoperative serum antisperm antibodies were correlated with pregnancy rates. Patients with a high agglutinin titre of 1/64 obtained a pregnancy rate of 23% (3/13). Those men who had no circulating antisperm antibodies in their blood had a significantly better chance in obtaining pregnancy (pregnancy rate 80%). In this study we accounted for an overall pregnancy rate of 51.5% (34/66) versus an overall patency rate of 84.8% (56/66). Neither long obstructive intervals nor high antisperm antibody titres should dissuade a surgeon from performing a vasovasostomy procedure.

不完全閉塞尿管における最大活動張力および収縮蛋白, コラーゲン含量の経時的変動

The sequential changes in maximum active stress, contractile proteins and collagen contents in the dilated ureter were determined in the rabbit ureters, which was partially obstructed for the intervals of 2 to 48 weeks. Maximum active stress and myosin content showed similar changes with the obstruction interval, i.e., both decreased first and then increased from week 2, and reached maximum at week 8, and after that, gradually decreased. Actin content did not show any significant changes. Collagen content showed almost the same changes as myosin content and maximum active stress by week 2. Then the collagen content increased rapidly from week 6 to week 10, and continued to increase gradually until 48 weeks after obstruction. A significant correlation was demonstrated between maximum active stress and myosin content while no significant correlation was found between maximum active stress and actin content. The maximum active stress decreased as the collagen content increased after week 8. Thus, there was a significant, negative correlation between them. Finally, the ratio of myosin content to collagen content (myosin/collagen) was related to maximum active stress. This ratio was more closely correlated with maximum active stress, indicating that myosin-collagen ratio is a good means of predicting contractility of the obstructed ureter.

Pressure-flow study after percutaneous nephrolithotripsy

In 46 patients treated with PNL in our hospital, the intervals from PNL to removal of a catheter indwelled in the nephrostomy were studied. The intervals were longer in the cases with ureteral stones than those with renal stones probably because of the different degrees of obstruction. To investigate the degree and the interval of upper urinary tract obstruction after PNL, Pressure-flow Studies were performed every or every other day after PNL in 5 cases with renal stones and 5 cases with ureteral stones, selected from 46 cases. In Pressure-flow Studies, intrapelvic pressures were measured while saline mixed with pigment was being dripping at a rate of 5 ml/min into the renal pelvis through the nephrostomy catheter. Saline initially reached into the urinary bladder at an average of 4.8 days after PNL (range 3 to 7 days) with a mean intrapelvic pressure of 37.6 cmH2O (range 28 to 52 cmH2O) in the cases with renal stones and at an average of 9.2 days (range 7 to 12 days) with a mean intrapelvic pressure of 27.0 cmH2O (range 9 to 43 cmH2O) in the cases with ureteral stones. Pressure-flow Studies were performed again a few days after the initial passage of saline into the urinary bladder in 2 of 10 cases. The intrapelvic pressures, 16 cmH2O and 13 cmH2O, respectively, several days after the initial passage of saline were lower than those, 35 cmH2O and 43 cmH2O, respectively, at the initial passage of saline. Therefore, it was likely that the proper interval of indwelling catheter after PNL was about 7 to 8 days, in the cases with renal stones and about 11 to 12 days in the cases with ureteral stones.

Bowel obstruction in patients with ovarian cancer: A search for prognostic factors

Patients with concomitant ovarian cancer and bowel obstruction were studied in an effort to find objective prognostic factors predictive of patient outcome. A total of 62 patients were followed from 31 to 354 weeks, and a total of 20 variables were considered in the analyses. At the end of the study 49 patients were dead of their disease, and 13 were alive (six disease free and seven with persistent disease). Survival probabilities of the sample were 79% at 6 weeks, 48% at 20 weeks, and 24% at 104 weeks. Univariate analyses revealed no significant difference in the survival times of medically versus surgically treated patients; age >60 years at diagnosis of cancer, presence of ascites, low serum albumin levels, elevated blood urea nitrogen levels, elevated alkaline phosphatase levels, lack of previous radiotherapy (p < 0.002 for all), advanced tumor stage, normal/ileus x-ray results, and a short diagnosis to obstruction interval (p < 0.04 for all) resulted in lower survival probabilities.

Vasectomy and Its Reversal

Techniques, results, complications, and medicolegal aspects of vasectomy are discussed in this article. Emphasis is placed on techniques that prevent spontaneous recanalization of the ends of the vas deferens after vasectomy. Factors that affect the reversibility of vasectomy are discussed. New microsurgical techniques of vasectomy reversal are described, and results of these new techniques are compared with results of nonmicrosurgical techniques of vasectomy reversal. Indications for bypass vasoepididymostomy during vasectomy reversal procedures, as well as techniques for performing vasoepididymostomy, are discussed.

Protein intake conditions the diuresis seen after relief of bilateral ureteral obstruction in the rat.

Natriuresis and diuresis occur in experimental animals after release of bilateral ureteral obstruction. Accumulation of urea and/or other natriuretic factors during the interval of complete obstruction may play a role in the ensuing postobstructive diuresis. The present experiments examine the potential role of dietary protein intake in conditioning the magnitude of the postobstructive diuresis after unilateral release of bilateral ureteral obstruction of 24-hr duration in the rat. Rats were fed isocaloric diets containing high (40% casein) or low (6% casein) protein for 4 weeks prior to obstruction. Rats fed a high protein diet had greater urine flows and fractional excretion of sodium and potassium after relief of obstruction than rats fed a low protein diet. Increased excretion of urea accounted for only part of the greater diuresis seen in rats fed a high protein diet. Hence, greater accumulation of other natriuretic factors during the period of obstruction in rats fed a high protein diet must play a role in the increased diuresis seen in this group of animals after release of obstruction.

Relationship of Gross Appearance of Vas Fluid During Vasovasostomy to Sperm Quality, Obstructive Interval and Sperm Granuloma

To study its intraoperative significance the gross appearance of the vas fluid found during vasovasostomy was compared to the quality of sperm in the fluid, obstructive interval and presence or absence of a histologically proved sperm granuloma. Data were obtained from 648 vasa in 340 patients. As the gross appearance increased in opacity, there was a small decrease in the proportion of morphologically normal, motile sperm (23 to 7 per cent) and a corresponding small increase in the proportion of sperm without tails (2 to 12 per cent). These minor trends had statistical but no intraoperative surgical significance. There was no variation in the proportion of vas fluid azoospermia with gross appearance. There was no significant difference in the gross appearance of the vas fluid with increasing obstructive interval. Finally, the presence or absence of a sperm granuloma had no effect on the gross appearance of the vas fluid, and the appearance had no predictive value relative to sperm granuloma. We conclude that the gross appearance of the vas fluid should not be used as a basis for operative decision-making during vasovasostomy.

Intraoperative Observations During Vasovasostomy in 334 Patients

This initial report from the Vasovasostomy Study Group concerns intraoperative data obtained during vasovasostomy from 639 vasa in 334 patients. These data are related to the obstructive interval (time from vasectomy to vasovasostomy) and to the presence or absence of histologically proved sperm granuloma at the old transected testicular end of the vas (vasectomy site). Rates of sperm absence from vas fluid at the testicular end increased with longer obstructive intervals and with absence of a sperm granuloma. If sperm were present in fluid at the testicular end of the vas, the quality was poorer when the obstructive interval lengthened and when sperm granuloma was absent. Vas luminal diameters at the testicular end were smaller when a sperm granuloma was present. These observations support the theory that a sperm granuloma at the vasectomy site may have a beneficial, pressure-releasing effect that could be favorable prognostically for fertility after vasovasostomy.

The significance of intravasal azoospermia during vasovasostomy: answer to a surgical dilemma

The presence of sperm in the intravasal fluid during vasovasostomy is an indication that the procedure will be successful in a large percentage of cases. Intravasal azoospermia (IVA) raises the possibility of an additional obstruction caused by fibrosis of the epididymis, a pressure related effect of vasectomy. The frequency of epididymal fibrosis may be related to the obstruction interval, the time between vasectomy and reversal. 161 microsurgical vasovasostomies were reviewed. In each case the presence or absence of sperm in the intravasal fluid was determined and when present, microscopic morphology and degree of motility were noted. 20 of the 161 patients had bilateral IVA; 10 were available for longterm follow-up. The obstruction interval ranged from 4-12 years, with an average of 7.5 years. 6 cases, with an average obstruction of 7 years, gained a normal sperm count within 1 year of the operation. The 4 cases remaining azoospermic had an average obstruction interval of 8.25 years. Gross appearance of the intravasal fluid was recorded for each of the 10 cases. For patients who gained a normal sperm count, the fluid was watery in 3 vasa, opalescent in 3 vasa, and creamy in 6. In cases remaining azoospermic, intravasal fluid was opalescent in 4 and creamy in 4. The data indicate that for obstruction intervals of less than 12 years, IVA during vasovasostomy is not usually associated with epididymal fibrosis and is reversible in over 1/2 of the cases. Therefore, finding IVA is not necessarily an indication for vasoepididymostomy. The tunica vaginalis should be opened and the epididymis inspected. Obstruction is characterized by the presence of a specific area of fibrosis with homogeneous proximal dilatation of the epididymal tubule which is visualized through the epididymal capsule and filled with creamy or white fluid. If the epididymis is not clearly obstructed, IVA is not an indication for vasoepididymostomy, especially at the shorter intervals. At longer intervals, more than 12 years, a higher degree of suspicion of epididymal sclerosis is appropriate.

Survival of a free flap after 20 hours of immediate post-operative venous occlusion

A case report illustrating survival of a free flap after 20 hours of immediate post-operative venous occlusion is presented. This represents the most dramatic salvage of a free flap in the authors' experience. It suggests that the late diagnosis of venous obstruction may not preclude satisfactory reexploration and repair of a thrombosed vein. Nevertheless, it is the authors' opinion that the shorter the interval of venous obstruction the more satisfactory will be revision of the anastomosis.

The undescended testis

We determined the feasibility and outcome of microsurgical reconstruction of the excurrent ductal tract in men with obstruction secondary to iatrogenic injury to the epididymis from hydrocelectomy.A retrospective chart review was done to identify men with iatrogenic injury to the epididymis or scrotal vas deferens and a history of hydrocelectomy. The outcome of microsurgical reconstruction was assessed by postoperative semen analysis. Pregnancy data were noted in patients actively attempting to conceive at a followup of 6 months or greater.Eight men were found to have iatrogenic injury to the epididymides (6) or scrotal vas deferens (2) due to previous hydrocelectomy. Injury was bilateral in 4 men and unilateral in 4 with contralateral testicular absence, dysfunction or obstruction resulting from different etiologies, rendering all patients azoospermic. The mean obstructive interval was 16 years (range 6 to 32). Bilateral and unilateral vasoepididymostomy was performed in 4 and 2 men each, and crossed vasovasostomy was performed in 2. Postoperative semen analysis data were available on 6 men. A patent microsurgical anastomosis was observed in 5 of 6 cases (83%). Four of the 5 men with patency had a followup of greater than 6 months, of whom 3 actively pursued conception. One pregnancy was achieved naturally and 1 was achieved by in vitro fertilization with intracytoplasmic sperm injection.Hydrocelectomy may result in inadvertent injury to the excurrent ductal tract, causing obstruction and infertility. Microsurgical reconstruction results in the restoration of spermatozoa to the ejaculate in 83% of cases. The return of spermatozoa to the ejaculate may provide the couple with an opportunity to conceive naturally or through assisted reproduction.