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Fertility outcome after repeat vasoepididymostomy.
F F Pasqualotto1, A Agarwal, M Srivastava
1Center for Advanced Research in Human Reproduction and Infertility, and Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
The Journal of Urology
|October 19, 1999
Summary
Repeat vasoepididymostomy offers a viable option for men with epididymal obstruction, with two-thirds achieving sperm in semen. Sperm retrieval for assisted reproduction is also recommended if azoospermia persists post-surgery.
Area of Science:
- Urology
- Reproductive Medicine
- Surgical Reconstruction
Background:
- Epididymal obstruction historically treated with surgical reconstruction.
- Repeat surgical reconstruction after failed vasoepididymostomy is evaluated.
- Comparison to sperm acquisition for assisted reproductive techniques (ART).
Purpose of the Study:
- To determine the efficacy of repeat vasoepididymostomy after initial failure.
- To assess if repeat surgery is a worthwhile option compared to ART.
Main Methods:
- 18 patients underwent repeat vasoepididymostomy by a single urologist.
- Cases categorized by obstruction etiology: vasectomy, congenital, inflammatory.
- Data collected on obstruction duration, epididymal fluid quality, anastomosis levels, semen analysis, and pregnancy rates.
Main Results:
- Overall patency rate of 66.7% (12/18 patients) with sperm in ejaculate.
- Patency rates varied by obstruction etiology (75% vasectomy, 85% congenital, 43% inflammatory).
- Natural conception occurred in 25% (3/12 couples), primarily in congenital obstruction cases.
Conclusions:
- Repeat vasoepididymostomy yields sperm in semen for two-thirds of men.
- Natural conception achieved in 25% of followed patients.
- Sperm retrieval and cryopreservation recommended for persistent or post-surgical azoospermia.