EXCRETORY AZOOSPERMIA - CONTRIBUTION OF E XPLORATORY AND CURATIVE SURGERY IN A SERIES OF 33 PATIENTS

Thirty-three patients with azoospermia of apparently excretory origin underwent surgery for epididyme-deferens anastomosis and/or epididymal sperm puncture. Pathology examinations of the epididymal fluid and bi opsies of the testicles or epididyme were performed at surgery. Based on the clinical presentation, sperm results and per-operative findings , patients were divided into six groups by etiology : idiopathic azoos permia (n = 5), post-infectious azoospermia (n = 15), agenesia of the excretory (n = 6) or secretory (n = 3) ducts, vasectomy (n = 2), and o bstruction of the ejaculatory ducts (n = 2). Peroperative identificati on of spermatozoids at epididymal puncture or biopsy was statistically more frequent in patients with agnesia of the excretory ducts than in patients with post-infectious or idiopathic azoospermia. Biopsies of the testicle led to the diagnosis of secretory azoospermia in 3 cases and revealed a functional parenchyma in all the other groups of patien ts. Epididyme-deferens anastomosis was performed in 45 % of the cases and was successful in 13 %. Rate of fertility with the intracytoplasmi c sperm injection was 33 %; there was no difficulty in using fresh or frozen sperm. Clinical pregnancy was continued to term with frozen spe rm. This study confirms that testicular function is preserved in excre tory azoospermia. With or without epididyme-deferens anastomosis, epid idymal spermatozoids can generally be preserved for later use. Couples should however be counselled on the delays to contraception which may vary from months to years.