Causes of suspected epididymal obstruction in Chinese men

To explore the causes of epididymal obstruction in China and the success of reconstructive surgery.

From February 2006 to December 2009, 134 consecutive azoospermic men with suspected epididymal obstruction underwent scrotal exploration. We excluded 11 men who had undergone vasectomy and 5 with inguinal hernia repair. The findings of scrotal exploration and outcomes of reconstructive surgery were reviewed.

Epididymal obstruction was found in 162 of 258 (62.8%) suspected blocked reproductive tract units (2/patient). The etiology of obstruction was idiopathic for 144 units (88.9%), infection for 16 (9.9%), and surgical for 2 (1.2%). The etiology for the remaining 96 obstructed units (37.2%) was intratesticular obstruction for 59 (61.5%), vasal obstruction for 24 (25%) and vasal atresia for 13 (13.5%). Of the 134 patients, we identified sperm in the epididymis on ≥ 1 side in 96 (71.6%). These 96 patients underwent vasoepididymostomy, and 46 (63.9%) had sperm on postoperative ejaculation.

Idiopathic obstruction was the most common cause of epididymal obstruction in this Chinese sample, which differed from the U.S. experience. Microsurgical vasoepididymostomy is effective for idiopathic epididymal obstruction.