A detailed questionnaire was sent to urologists in Austria, Switzerland and West Germany on the frequency of contraceptive vasectomies, vasectomy reversal, technique and success rates. The response rate was 859 of 2,137 (40.2%). The rate of annual contraceptive vasectomies averaged 28,519 or 378 vasectomies per million inhabitants. The rate of vasovasostomies and vasoepididymostomies was 8.3 and 3.8 procedures per million inhabitants, respectively. A macroscopic technique was used by 9.5% of the responding urologists, loupes were used by 58.5% and an operating microscope by 32%. The majority (74.1%) preferred a 1-layer technique and an unstented anastomosis (84.4%). The average patency and pregnancy rates were 73 and 47%, respectively, for vasovasostomy and 45 and 18%, respectively, for vasoepididymostomy. A total of 78 alloplastic spermatoceles was reported, with detection of motile spermatozoa in 19 and pregnancy in 1.
Free carnitine in human semen originates predominantly in the epididymis. The role of carnitine in the evaluation of different forms of obstructive azoospermia was studied in 42 patients. In 14 of the men, a bilateral vasectomy had been performed. In the remaining 28 patients, the occlusion was located within the epididymis. In postvasectomy cases and where the occlusion was located in the cauda epididymidis, carnitine concentrations were low, with mean values of 115.57 mumol/l and 121.28 mumol/l, respectively. When the occlusion was located in the corpus epididymidis, the mean value increased to 194.72 mumol/l. In patients having obstruction of the caput epididymidis or of the rete testis, the mean value of free carnitine was 416.0 mumol/l. After vasovasostomy, a return of free carnitine concentration to the normal range was observed in 10 of 12 cases. The results indicate that there is a significant correlation in patients with obstructive azoospermia between the concentration of free carnitine and the anatomic site of the obstruction. These findings may lead to important conclusions concerning therapy and prognosis for patients presenting with this condition.
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