Scrotal Exploration in 123 Azoospermic Patients: The Results of Surgery for Obstructive Azoospermia

Abstract

During the last eight years, scrotal exploration for attempted vasoepididymostomy was performed in 123 azoospermic patients at the King Faisal Specialist Hospital and Research Centre. All patients had normal or slightly elevated serum FSH, and normal-size testes (at least on one side). Testicular biopsy was not recommended but had already been done before referral in 73 patients and was reported to show normal spermatogenesis or mild hypospermatogenesis. Vasoepididymostomy could be performed in only 83 (67.5%) patients using the conventional fistula technique in 34 patients and microsurgical single tubule anastomosis in 49 patients. Sixty-seven patients were followed between six and 30 months (mean 17.8 months). Among these patients, 25 produced sperm in the ejaculate with a patency rate of 37.3 percent and seven patients impregnated their wives, for a pregnancy rate of 10.4%. These pregnancies resulted in four living children. The patency rate with the conventional fistula technique was (7/ Azoospermia can result from either failure of the testes to produce sperm or obstruction anywhere along the seminal tract. Small semen volume and a low fructose level in the seminal fluid indicate obstruction at the ejaculatory duct or congenital absence of the vas deferens.1 Epididymal obstruction can result from several congenital and acquired causes. Congenital epididymal abnormalities can range from absence of the body and tail of the epididymis along with the vas deferens, seminal vesicles and ejaculatory ducts to skip areas within the epididymal body and nonunion between the epididymis and the vas deferens. Surgical correction is only feasible when there is a patent vas deferens and sperm within a portion of the epididymis. Acquired epididymal obstruction is more likely to occur within the epididymis secondary to inflammatory processes, vasectomy and iatrogenic injury during transscrotal operations such as spermatocelectomy, testicular biopsy or hydrocelectomy.2 Diagnosis of obstructive azoospermia is supported by normal-size testes, normal serum FSH and normal spermatogenesis on testicular biopsy. Epididymal obstruction is in favor with palpable vas deferens, positive fructose in seminal fluid and distended epididymis.3 Surgically correctable epididymal obstructions are managed by anastomosing the patent vas deferens to the epididymal tubule proximal to the site of obstruction. This can be achieved by basically two techniques: the conventional fistula technique and the microsurgical single tubule anastomosis technique.The epididymal tubule is about 20 feet long, coiled and squeezed into a 2-inch length. The dilated epididymal tubule has a diameter of 0.1 to 0.2 mm.4 Surgery on such a fine structure definitely needs magnification for achieving anatomic specificity and a high percentage of patent anastomosis.We present our experience with scrotal exploration for 123 azoospermic patients, and the results of vasoepididymostomy performed in 83 patients during the last eight years.

Current progress on the curative effects of vasoepididymostomy for patients with obstructive azoospermia: An updated systematic review and meta‐analysis of human studies

“…All included studies were published between 1978 and 2021, with a cohort size ranging from 8 to 255 patients. Among them, 16 studies were conducted in China, five in Japan, 15 in America, four in India, two in Korea, two in Sweden, two in Saudi Arabia, one in Canada, one in Belgium, one in Egypt, one in Romania, and one in Slovenia, 4–9,12–56 and Table S1.…”