Delayed appearance of sperm after end-to-side vasoepididymostomy

The frequency and timing of the delayed appearance of sperm following an end-to-side vasoepididymostomy were determined in 89 patients. The surgical patency rate, defined as greater than 1 million sperm in the ejaculate, was 56% (50 of 89 consecutive patients). None of the 7 patients without sperm in the epididymal fluid at the anastomosis had sperm in the ejaculate postoperatively. Of the remaining 82 patients 31 had sperm on initial semen analysis within 3 months postoperatively. Seven of the 51 patients whose initial postoperative semen sample revealed azoospermia were lost to followup. Among the remaining 44 patients 18 (41%) had delayed appearance of sperm in the ejaculate (mean delay 6 months, range 3 to 15). The ultimate mean sperm count and motility in the patients with initially positive postoperative semen samples were not significantly different from those in patients with delayed appearance of sperm. In addition, the delayed anastomotic obstruction for both groups was the same (10% and 11%, respectively). Our results demonstrate that delayed appearance of sperm after end-to-side vasoepididymostomy is common and that the prognosis for patients with delayed appearance of sperm is not significantly worse than that for patients with sperm on the initial semen analysis.