[Seminal tract reconstruction: 15 years experience]

Azoospermia in two spermiograms, normal FSH and normal testicle size are sufficient for the diagnosis of excretory azoospermia and constitute an indication for surgery. Over the last 15 years, in 642 men an epididymo-vasostomy was performed for inflammatory (51%), inborn (44%) or acquired (5%) epididymal obstruction. In 327 selected cases permeability ranged between 11 to 76% according to the location of the anastomosis and fertility followed in 0-52%. Vaso-vasostomy was done in 724 men. Depending on the time after sterilisation or herniotomy obstruction, permeability ranged between 52% and 92%, fertility between 38% and 74%. Double-layered anastomosis with sealing of the anastomoses by fibrin glue improved the results. Special operations for vas mobilisation and testicle elevation which avoid tension upon the anastomosis are outlined. In four men with long obstructions of the vas, testicle transposition into the inguinal area was performed; three of them had a positive postoperative spermiogram and two of them fathered a child. With increasing duration of obstruction the quality of postoperative spermiograms decreases. Sperm autoantibodies were significantly elevated in only 3% of 531 men, and in most cases normal values were seen after relief of obstruction. Reasons of seminal anastomoses are: defective technique, sperm leak, traction upon the anastomosis, infection and epididymal damage. The frequency with which the operation is performed is the main determinant of the competence of the surgeon and the chances of success.