OPEN VERSUS CLOSED EPIDIDYMAL SPERM RETRIEVAL IN MEN WITH SECONDARILYOBSTRUCTED VASAL SYSTEMS - A PRELIMINARY-REPORT

Objective To evaluate and compare sperm quality and suitability for in tracytoplasmic sperm injection (ICSI) from open and percutaneous epidi dymal aspiration in men with obstructive azoospermia, and to determine the relevance of epididymal morphology. Patients and methods A series of 20 men undergoing vasectomy reversal were evaluated by percutaneou s (PESA) and open epididymal sperm aspiration (MESA) before undergoing surgery for reversal. Two samples were taken with PESA, one with the needle in situ (PESA1) and the second while withdrawing the needle (PE SA2). Epididymal morphology was graded as normal, distended and grossl y distended. Five men undergoing vasectomy served as a control, nonobs tructed group for percutaneous aspiration. Analysis of the aspirates w as performed immediately after operation with no knowledge of the trea tment, and aspiration was considered successful if sperm suitable for ICSI were retrieved. Results In the obstructed group, 15 of 20 men had successful PESA and 13 of these also had successful MESA. PESA was su ccessful bilaterally eight times compared with MESA on five occasions; two men with successful PESA had no success with MESA. PESA2 was five times more successful than PESA1. Only one PESA in the non-obstructed group was suitable for ICSI. PESA was successful in 21 of 25 distende d or grossly distended epididymi compared with only three of 21 non-di stended systems. Conclusion PESA is a viable alternative to MESA in pa tients with obstructive azoospermia, particularly when associated with clinically distended epididymi.