Microsurgical end-to-end and end-to-side epididymovasostomy to correct occlusive azoospermia

Reconstruction of the duct system using microsurgical technique represents an anatomically more attractive approach to correction of occlusive azoospermia than the conventional sperm fistula operations. The microsurgical technique of Silber entails transection of the entire epididymis in progressively more cranial planes. After microsurgical dissections of testicle specimens, we developed a different technique: dissection of a single loop of the ductus epididymis and connection to the ductus deferens, performed either as a two-layer end-to-end or as an end-to-side anastomosis. To reveal patency of each single anastomosis, the operations were performed unilaterally. Twenty-eight men were operated upon. They were referred from urology departments after standard investigations including repeated sperm tests. In 7 patients (25%) the prerequisites for an anastomosis were not present. Twelve patients were primarily operated upon with the end-to-end technique. Six of them have produced sperms in their specimens. Nine patients were operated upon with the end-to-side anastomosis. So far, five of these have presented positive sperm tests but the follow-up period is relatively short in this part of the series. During the investigation, it became evident that both the identification of sperms or fragments in the epididymal fluid and an adequate flow are prerequisites for successful surgery.