[Current aspects of surgical restoration of fertility]

Obstruction of the seminal ducts is the cause of infertility in about 5% of patients. It can be congenital or arise as the result of secondary changes. The reconstruction of the duct undertaken depends on the site of the obstruction. The introduction of microsurgical techniques has revolutionized the treatment of male infertility.A tubulovasostomy is carried out if the obstruction lies in the region of the epididymis. Such an anastomosis requires, owing to the minute anatomical relationships involved, a microsurgical procedure. For an obstruction of the vas deferens a vasovasostomy is required. Many investigations have shown that microsurgical techniques are also necessary for this procedure if a satisfactory success rate is to be achieved. The double-layer technique is the standard method for vasovasostomy. Transurethral resection of the ejaculatory ducts (TURED) is required for the very rare obstruction in this region, and men with an obstruction here cannot be regarded as forming a homogeneous group.Before advising an infertile couple it is necessary to investigate the individual conditions and possibilities. Because of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken.