The long-term results of surgery for obstructive azoospermia

Thirty azoospermic patients with normal testes and normal serum FSH levels had scrotal exploration with photographic record of the appearance of the epididymes and vasography; bilateral epididymovasostomies were done is possible, with vasovasostomies if they were coexisting vasal blocks. Follow-up studies showed no success when the epididymes were empty (Type 1), when the vasa were absent or malformed (Type 2), or when tubular dilatation was confined to the heads of the epididymes; all of the latter cases had coexisting sinusitis, bronchitis or bronchiectasis (Type 4--Young's syndrome). Five patients with post-inflammatory disease had epididymes distended down to their tails (Type 3), and 3 also had vasal blocks. Three achieved sperm counts greater than 10 million per ml and impregnated their wives. Ten of 16 vasectomy reversals done by a similar side-to-side technique were successful. A simple classification of obstructive azoospermia is described and it is concluded that in about 50% of cases the underlying cause of failure in sperm transport remains obscure.