MALE-INFERTILITY AFTER SURGERY FOR IMPERFORATE ANUS

Congenital abnormalities of the genitourinary tract often coexist, and cryptorchidism is common in patients who have had imperforate anus. T wenty men who had pull-through procedures for imperforate anus in infa ncy have been evaluated for infertility. Seven had coexisting renal ab normalities, 4 had had recurrent epididymitis, 3 had had bilateral orc hidopexies (at age 7 to 12), 2 had spina bifida, and 1 had a pituitary adenoma. Seven had no ejaculate (aspermia), 11 were azoospermic, 1 wa s severely oligozoospermic, and 1 had a normal sperm concentration in a small volume of ejaculate. Both vasa were blocked in 5 men, and this appeared to be a result of the original operative procedure, One vas was blocked in another 7 patients who had abnormalities on the contral ateral side; three had epididymal blocks after epididymitis, and four had congenital malformations associated with an absent or ectopic kidn ey. After reconstruction (4), insertion of sperm reservoirs (4), micro scopic epididymal sperm aspiration (2), or artificial insemination (1) , sperm were retrieved from 9 men (ejaculated by 4)2 pregnancies occur red. Male infertility after treatment of imperforate anus in infancy c an be related to a wide variety of causes, some of which are amenable to treatment. (C) 1995 by W.B. Saunders Company