MICROSURGICAL VASOEPIDIDYMOSTOMY - REFINEMENTS AND RESULTS

We describe 110 consecutive evaluable vasoepididymostomy procedures pe rformed on 107 azoospermic men who had either bilateral epididymal obs truction, or unilateral obstruction with an absent or nonfunctional co ntralateral testis. End-to-end procedures were performed in 93 cases a nd end-to-side anastomoses were done in 17. Previously described surgi cal techniques were modified to perform the second layer anastomosis b etween the vasal sheath and the epididymal tunic, instead of using the muscular layer of the vas. Although patency and pregnancy rates were similar after both types of procedures, 40% of the men again became az oospermic after an end-to-side anastomosis, whereas the stricture rate was only 13% after vasoepididymostomy using an end-to-end anastomosis . Of the 107 men 91 have been followed for at least 1 year postoperati vely or have achieved a pregnancy with their partner, and 64 (70%) had sperm in the ejaculate postoperatively. Ten men had partners with fem ale factor infertility and none of these couples achieved pregnancy. T he overall pregnancy rate was 25 of 81 couples (31%) without female fa ctor infertility. Of the 64 men with patent anastomoses 25 (39%) contr ibuted to a pregnancy postoperatively. Excluding the 7 men with patent anastomoses but definite female factor infertility, the pregnancy rat e was 25 of 57 (44%).