Scrotal exploration in 123 azoospermic patients: The results of surgery for obstructive azoospermia

During the last eight years, scrotal exploration for attempted vasoepididymostomy was performed in 123 azoospermic patients at the King Faisal Specialist Hospital and Research Centre. All patients had normal or slightly elevated serum FSH, and normal-size testes (at least on one side). Testicular biopsy was not recommended but had already been done before referral in 73 patients and was reported to show normal spermatogenesis or mild hypospermatogenesis. Vasoepididymostomy could be performed in only 83 (67.5%) patients using the conventional fistula technique in 34 patients and microsurgical single tubule anastomosis in 49 patients. Sixty-seven patients were followed between six and 30 months (mean 17.8 months). Among these patients, 25 produced sperm in the ejaculate with a patency rate of 37.3 percent and seven patients impregnated their wives, for a pregnancy rate of 10.4%. These preganancies resulted in four living children. The patency rate with the conventional fistula technique was (7/26) 26.9%,a nd with microsurgical technique (18/41) 43.9%; the difference is statistically significant. Microsurgical single tubule vasoepididymostomy is strongly recommended for the treatment of obstructive azoospermic patients, as it gives a higher percentage of successful anastomosis.