ADVERSE-EFFECTS ON VASOEPIDIDYMOSTOMY OUTCOMES FOR MEN WITH CONCOMITANT ABNORMALITIES IN THE PROSTATE AND SEMINAL-VESICLE

Purpose: Following microsurgical vasoepididymostomy as many as 85% of men have sperm in the ejaculate, yet only 30 to 50% will spontaneously father children. We examined the possibility that there may be concom itant abnormalities in the prostate and seminal vesicle, which may be associated with low pregnancy rates. Materials and Methods: Transrecta l ultrasound was performed in azoospermic men with suspected epididyma l obstruction, excluding those who had undergone vasectomy, to identif y abnormalities of the seminal vesicles and ejaculatory ducts. Microsu rgical vasoepididymostomy was attempted in all men. Results: Transrect al ultrasound revealed ejaculatory duct dilatation in 13 of 40 men (33 %), although only 3 had accompanying seminal vesicle dilatation. Two m en had atrophic seminal vesicles with normal ejaculatory ducts. At sur gery 8 of 40 patients (20%) were deemed to have irreparable conditions . For the 27 men followed at least 6 months postoperatively patency an d pregnancy rates were 75 and 22%, respectively. Mean sperm counts plu s or minus standard deviation were significantly higher in men without compared to those with seminal vesicle or ejaculatory duct abnormalit ies (43 +/- 68 versus 5.7 +/- 6.9 x 10(6) sperm per mi., respectively) , and so was the percentage of motile sperm (30 +/- 16% versus 1.2 +/- 2.2%, respectively). Pregnancy rates were also higher in men without (6 of 19, 32%) than with (0 of 8, 0%) seminal vesicle or ejaculatory d uct abnormalities. Conclusions: Transrectal ultrasound detected abnorm alities of the seminal vesicles and ejaculatory ducts are common in me n with suspected epididymal obstruction. These abnormalities are assoc iated with a poor outcome for vasoepididymostomy. We recommend that al l men with suspected epididymal obstruction undergo transrectal ultras ound before any attempted reconstruction.