Microsurgical vasoepididymostomy: refinements and results

We describe 110 consecutive evaluable vasoepididymostomy procedures performed on 107 azoospermic men who had either bilateral epididymal obstruction, or unilateral obstruction with an absent or nonfunctional contralateral testis. End-to-end procedures were performed in 93 cases and end-to-side anastomoses were done in 17. Previously described surgical techniques were modified to perform the second layer anastomosis between the vasal sheath and the epididymal tunic, instead of using the muscular layer of the vas. Although patency and pregnancy rates were similar after both types of procedures, 40% of the men again became azoospermic after an end-to-side anastomosis, whereas the stricture rate was only 13% after vasoepididymostomy using an end-to-end anastomosis. Of the 107 men 91 have been followed for at least 1 year postoperatively or have achieved a pregnancy with their partner, and 64 (70%) had sperm in the ejaculate postoperatively. Ten men had partners with female factor infertility and none of these couples achieved pregnancy. The overall pregnancy rate was 25 of 81 couples (31%) without female factor infertility. Of the 64 men with patent anastomoses 25 (39%) contributed to a pregnancy postoperatively. Excluding the 7 men with patent anastomoses but definite female factor infertility, the pregnancy rate was 25 of 57 (44%).