[Surgical treatment of obstructive azoospermia]

In 23 infertile men the diagnosis of azoospermia was established. Bilateral biopsy of the testes was made, in four patients primary deficiency of spermiogenesis was revealed, in another four patients the Sertoli cells only syndrome. In a group of 3 men with hypospermiogenesis revision revealed severe hypoplasia of the epididymis which in context with the bioptic finding did not give hope of successful surgery. In the group of four men with normal spermiogenesis revision revealed in one obliteration of the terminal portion of the d. deferens, treated by transurethral discision of the colliculus and in three its partial or total agenesis. In one of the three latter cases bilaterally artificial spermatoceles were implanted which function satisfactorily; in the aspirated contents, however, even after several months only non-motile sperm cells were found. In seven patients epididymovasoanastomosis was performed by the microscopic technique--five times unilateral and twice bilateral. In one patient a condition after bilateral vasectomy was involved which was resolved by vasovasoanastomosis. In three patients after epididymovasoanastomosis azoospermia persists. In another two patients the check-up spermiogram revealed a positive finding, the wife of one of the patients is pregnant at the moment. In one patient the result of the operation cannot be evaluated yet due to a short time interval after operation. One patient did not come for a check-up examination. The patient after vasovasoanastomosis has a positive spermiogram with 38 million sperm cells per ml. In one patient with a discision of the colliculus the spermiogram is negative. The cumulative index of patient anastomoses reported in the literature is approximately 45%, the percentage of pregnancies only 17-18%.