Microsurgical method of reuniting ductus epididymis

Based upon the experience of microsurgical treatment of 24 patients (45 operations), we consider epididymitis to be the main cause of obstructive aspermia. Thirty-eight interventions have been performed on the occluded epididymides. A new method of seminal vias restoration evolved by us is a microsurgical epididymoneostomy. This method consists of creating an anastomosis between two parts of the ductus epididymis, bypassing its scarred focus, with or without resection of the latter. Twelve such operations were performed in six patients. Follow-up in four of the patients revealed sperm in all cases. Although fertilizing characteristics of the sperm thus obtained were low, they were better than those obtained by other methods, excluding vasovasostomy, the simplest operation providing very good results. In dealing with spermostasis of obscure genesis, we attach special importance to the "isthmic" tubule, i.e., the part of the ductus epididymis connecting its corpus and cauda. Shut-down of this tubule by shunting epididymo-epididymoanastomosis resulted in spermatozoa appearance in an ejaculate in two of three such patients. We recommend application of microsurgical technique in the treatment of obstructive aspermia.