Unilateral testicular obstruction: orchidectomy or reconstruction?

Unilateral testicular obstruction can cause infertility in man by reducing sperm output, or by stimulating antisperm antibody production. Amongst 125 subfertile men with unilateral blocks, the causes were defined as post-infective (n = 72), post-traumatic (n = 41) or congenital (n = 12) by surgical exploration. Of these, 50 had severe oligozoospermia or azoospermia, and another 30 had oligozoospermia; 67 had significantly raised serum antisperm antibody titres. The outflow tracts were reconstructed in 87 men, while in 24 the obstructed testis was removed and replaced with a prosthesis. Follow-up information is available in 104 men. Reconstruction produced significant improvement in sperm concentration in the ejaculate but little change in antisperm antibody titres. Orchidectomy lowered seminal plasma antibody titres and had no effect on sperm output. Orchidectomy plus prednisolone was most effective in terms of pregnancies produced in the female partners. Testicular biopsies showed that spermatogenesis was normal on the side of the block in 90% of cases, whereas it was impaired in the contralateral testis in 40% of men. Although sperm output can be improved by reconstruction, the stimulus to antibody production is more reliably eliminated by orchidectomy. Sperm concentration, antisperm antibody titres and bilateral testicular biopsy results should be taken into account before making a final therapeutic recommendation in men with unilateral testicular obstruction.