MICROSURGICAL CORRECTION OF POSTTESTICULAR OBSTRUCTION - PEROPERATIVEFINDINGS AND POSTOPERATIVE SEMEN QUALITY

Exploration for microsurgical reconstruction of the vas deferens or it s epididymal junction was performed in 47 consecutively treated men. E pididymovasostomy was planned in 27 cases. Malformation was found in f ive and Young's syndrome in nine, and most of the others had a history of urogenital infections. Reconstruction was accomplished in 17 cases . Nine were azoospermic preoperatively. Four (three with Young's syndr ome/malformation) remained so, whereas patency was demonstrated in fou r and one did not supply a semen specimen postoperatively. Eight had s evere unexplained oligozoospermia preoperatively, and in four of them the sperm counts normalized postoperatively while the other four remai ned oligozoospermic. In no case did preoperative oligozoospermia progr ess to azoospermia postoperatively. Complete normalization of all sper miogram parameters occurred in only two cases after epididymovasostomy . Of the 20 who underwent reversal of vasectomy 17 provided semen for postoperative testing. 16/17 specimens contained spermatozoa, but sper miograms, including penetration tests, were completely normal in only three cases. This study indicates a discrepancy between good patency a nd good semen quality. Our study also suggests that some men with unex plained severe oligozoospermia are as likely to benefit from epididymo vasostomy as are azoospermic men.