Two-suture Single-armed Longitudinal Intussusception Vasoepididymostomy for Obstructive Azoospermia: Report of Patients Characteristics and Outcome

Purpose: To evaluate the efficacy of microsurgical two-suture single-armed longitudinal intussusception vasoepididymostomy for patients with obstructive azoospermia (OA) attending our institution.

Methods: The study enrolled all patients with OA due to epididymal obstruction who had undergone microsurgical two-suture single-armed longitudinal intussusception vasoepididymostomy in the study hospital from July 2009 to November 2012. All procedures were performed by a single surgeon in a university teaching hospital. The inclusion criteria include: documented azoospermia in at least two consecutive semen samples collected 6 weeks apart, with normal ejaculate volume and semen pH. All patients had at least one normal-sized testis and normal FSH levels. All patients had had testicular biopsies to confirm active spermatogenesis.

Results: Twenty-two patients with OA due to epididymal obstruction had undergone 22 microsurgical vasoepididymostomy procedures. The mean age of patients and their female partners was 31 and 25 years, respectively. All procedures were performed by Monoski's two single-armed suture longitudinal intussusception techniques. The mean operating time of unilateral and bilateral procedures was 145 and 214 min, respectively. The median duration of follow-up was 18 (range, 6-30) months. The overall patency rate was 59 %; being 50 and 70 % for unilateral and bilateral procedures, respectively. The overall paternity rate was 36 %. Natural pregnancy was achieved in three cases, and assisted reproduction was used in five using fresh ejaculated semen.

Conclusions: Two-suture single-armed longitudinal intussusception microsurgical vasoepididymostomy is a feasible option for couples with male factor infertility due to epididymal OA. Reasonable patency outcomes were achieved in the present series of cases. Individualized counseling, with expectations based on obstructive etiology and anticipated surgical outcomes, should be offered to couples before resorting to assisted reproduction. Longer follow-up is required to ascertain long-term patency, pregnancy outcomes, and late failures.