EFFECTIVENESS OF CROSSOVER TRANSSEPTAL VASOEPIDIDYMOSTOMY IN TREATINGCOMPLEX OBSTRUCTIVE AZOOSPERMIA

Objective: To review the indications, surgical technique, and results of crossover transseptal vasoepididymostomies for treatment of complex obstructive azoospermia and oligospermia. Design: Retrospective revie w of our experience with crossover transseptal end-to-side vasoepididy mostomies in 10 men. Interventions: Ten men underwent crossover transs eptal end-to-side vasoepididymostomies. Nine men had primary and one h ad secondary infertility. Seven men were azoospermic, and the remainin g 3 had severe oligospermia (sperm density <1 X 10(6)/mL). All had a c ombination of irreparable ipsilateral ductal obstruction or agenesis w ith a normal testis and a poorly functional or absent contralateral te stis. Contralateral testicular atrophy was associated with a prior her nia repair in 3 men, varicocele-induced atrophy in 2, and severe orchi tis in 2. Cryptorchidism, testicular torsion, and one unknown cause we re reported for three others. Congenital absence of the vas deferens c aused the ipsilateral ductal pathology in 5 men. Three men had a vas i njury from pediatric inguinal surgery, and 2 had an idiopathic vas obs truction. Results: Twelve microsurgical crossover transseptal vasoepid idymostomies were performed (2 men had repeat procedures). Anastomosis was performed to the caput in five men, the corpus in two, and the ca uda in three men. Eight of nine men followed for 6 months or more had sperm in their ejaculate. Two of seven couples have established pregna ncies. Total sperm counts ranged from 18 to 201 X 10(6) (mean, 98.1 X 10(6)) with motility of 5% to 37% (mean, 13%). Men with congenital abs ence of the vas deferens had significantly lower postoperative total s perm counts than men with all other causes of ductal pathology: 37.8 X 10(6) versus 135 X 10(6). No other characteristics (type of infertili ty, preop semen analysis, cause of testicular pathology, site of epidi dymal anastomosis) were useful predictors of postoperative sperm count s. Conclusions: If there is a solitary functioning testis with irrepar able excurrent ductal obstruction or agenesis, a crossover transseptal vasoepididymostomy can restore patency in most men.