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Obstructive Azoospermia and Vasoepididymostomy

  • Anthony J. ThomasJr.
  • Osvaldo F. Padron

Abstract

Excurrent duct obstruction is a potentially reversible cause of male infertility. It can occur anywhere along the ductal system from the rete testes (empty epididymis syndrome) to the ejaculatory ducts. The incidence of obstructive azoospermia among infertile men is approximately 7% to 10%. Elective vasectomy is the most common cause of ductal obstruction. Other causes of ductal obstruction include those related to congenital anomalies ranging from total absence of the vasa deferentia, seminal vesicles, and ejaculatory ducts to a minor dysjunction between vasa and epididymides or obstruction secondary to scarring of the tubules as a result of prior infection, inflammation, trauma, or iatrogenic injury to the epididymis or vas deferens. Figure 16.1 is an algorithm suggested for evaluating and treating patients who may have an obstructive or non-obstructive problem causing azoospermia.

Keywords

Male Infertility Ejaculatory Duct Internal Inguinal Ring Sperm Retrieval Obstructive Azoospermia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Amann RP, Howards SS. Daily spermatozoal production and epididymal spermatozoal reserves of the human male. J Urol 1980; 124: 211–215.PubMedGoogle Scholar
  2. 2.
    Turner TT, Cesarini DM. The ability of the rat epididymus to concentrate spermatozoa. J Androl 1983; 3: 197–202.Google Scholar
  3. 3.
    Wong PYD, Au CL, Nagi HK. Electrolyte transport in the rat epididymis: its possible role in sperm maturation. Int J Androl 1978; 2 (suppl): 608–628.CrossRefGoogle Scholar
  4. 4.
    Robaire B, Hermo L. Efferent ducts, epididymis and vas deferens: structure, function and their regulation. In: Knobil E, Neil J, eds. The Physiology of Reproduction. New York: Raven Press; 1988: 999–1080.Google Scholar
  5. 5.
    Turner TT. On the epididymis and its role in the development of the fertile ejaculate. J Androl 1995; 16: 292–298.PubMedGoogle Scholar
  6. 6.
    Bedford JM. The status and state of the human epididymis (review). Hum Reprod 1994; 9: 2187–2199.PubMedCrossRefGoogle Scholar
  7. 7.
    Anguiano A, Oates RD, Amos JA, et al. Congenital absence of the vas deferens. A primarily genital form of cystic fibrosis. JAMA 1992; 267: 1794–1797.PubMedCrossRefGoogle Scholar
  8. 8.
    Mercier B, Verlingue C, Lissens W, et al. Is congenital bilateral absence of the vas deferens a primary form of cystic fibrosis? Analysis of the CFTR gene in 67 patients. Am J Hum Genet 1995; 56: 272–277.PubMedGoogle Scholar
  9. 9.
    Silber SJ. Pregnancy with sperm aspiration from the proximal head of the epididymis: a new treatment for congenital absence of the vas deferens. Fertil Steril 1988; 50: 525–528.PubMedGoogle Scholar
  10. 10.
    Silber S, Ord T, Balmaceda J, et al. Congenital absence of the vas deferens. The fertilizing capacity of human epididymal sperm. N Engl J Med 1990; 323: 1788–1792.PubMedCrossRefGoogle Scholar
  11. 11.
    Bourne H, Watkins W, Speirs A, et al. Pregnancies after intracytoplasmic injection of sperm collected by fine needle biopsy of the testis. Fertil Steril 1995; 64: 433–436.PubMedGoogle Scholar
  12. 12.
    Chen CS, Chu SH, Soong YK, et al. Epididymal sperm aspiration with assisted reproductive techniques: difference between congenital and acquired obstructive azoospermia? Hum Reprod 1995; 10: 1104–1108.PubMedGoogle Scholar
  13. 13.
    Schlegel PN, Palermo GD, Alikani M, et al. Mi-cropuncture retrieval of epididymal sperm with in vitro fertilization: importance of in vitro micromanipulation techniques. Urology 1995; 46: 238–241.PubMedCrossRefGoogle Scholar
  14. 14.
    Tsirigotis M, Craft I. Sperm retrieval methods and ICSI for obstructive azoospermia (review). Hum Reprod 1995; 10: 758–760.PubMedGoogle Scholar
  15. 15.
    Tucker MJ, Morton PC, Witt MA, et al. Intracytoplasmic injection of testicular and epididymal spermatozoa for treatment of obstructive azoospermia. Hum Reprod 1995; 10: 486–489.PubMedGoogle Scholar
  16. 16.
    Sabanegh E, Thomas AJ. Effectiveness of crossover transseptal vasoepididymostomy in treating complex obstructive azoospermia. Fertil Steril 1995; 63: 392–395.PubMedGoogle Scholar
  17. 17.
    Scorer CG, Farrington GH. Congenital Deformities of the Testis and Epididymis. New York: Appleton-Century-Crofts; 1971.Google Scholar
  18. 18.
    Wagenknecht LV. Alloplastic spermatocele. In: Goldstein M, ed. Surgery of Male Infertility. Philadelphia: W.B. Saunders; 1995: 142–158.Google Scholar
  19. 19.
    Young D. Surgical treatment of male infertility. J Reprod Fertil 1970; 23: 541–542.PubMedCrossRefGoogle Scholar
  20. 20.
    Le Lannou D, Jezequel P, Blayau M, et al. Obstructive azoospermia with agenesis of the vas deferens or with bronchiectasis (Young’s syndrome): a genetic approach. Hum Reprod 1995; 10: 339–341.Google Scholar
  21. 21.
    Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril 1978; 30: 565–571.PubMedGoogle Scholar
  22. 22.
    Silber SJ. Microsurgery for vasectomy reversal and vasoepididymostomy. Urology 1984; 23: 505–524.PubMedCrossRefGoogle Scholar
  23. 23.
    Belker AM, Thomas AJ Jr, Fuchs EF, et al. Results of 1469 microsurgical vasectomy reversals by the vasovasostomy study group. J Urol 1991; 145: 505–511.PubMedGoogle Scholar
  24. 24.
    Goldstein M. Microsurgical vasoepididymostomy: end-to-end anastomosis. In: Goldstein M, ed. Surgery of Male Infertility. Philadelphia: W.B. Saunders; 1995: 120–127.Google Scholar
  25. 25.
    De wire DM, Thomas AJ. Microsurgical end-to-side vasoepididymostomy. In: Goldstein M, ed. Surgery of Male Infertility. Philadelphia: W.B. Saunders; 1995: 128–134.Google Scholar
  26. 26.
    Thomas AJ. Vasoepididymostomy. Urol Clin North Am 1987; 14: 527–538.PubMedGoogle Scholar
  27. 27.
    Thomas AJ, Nagler HM. Testicular biopsy and vasography for evaluation of male infertility. Urol Clin North Am 1987; 14: 167–176.PubMedGoogle Scholar
  28. 28.
    Silber SJ. Results of microsurgical vasoepididymostomy: role of epididymis in sperm maturation. Hum Reprod 1989; 4: 298–303.PubMedGoogle Scholar
  29. 29.
    Fuchs EF. Restoring fertility through epididy-movasotomy. Contemp Urol 1991; 3: 27–38.Google Scholar
  30. 30.
    Thomas AJ. Microsurgical end-to-side vasoepididymostomy: analysis and outcome of 161 procedures. Presented at the 88th annual meeting of the American Urological Association, San Antonio TX, May, 1993.Google Scholar
  31. 31.
    Schlegel PN, Goldstein M. Microsurgical vasoepididymostomy: refinements and results. J Urol 1993; 150: 1165–1168.PubMedGoogle Scholar
  32. 32.
    Schoysman R. Vasoepididymostomy: a survey of techniques and results with consideration of delay of appearance of spermatozoa after surgery. Acta Eur Fertil 1990; 21: 239–245.PubMedGoogle Scholar
  33. 33.
    Belker AM, Jimenez-Cruz DJF, Kelami A, et al. Alloplastic spermatocele: poor sperm mobility in intraoperative epididymal contraindicates prosthesis implantation. J Urol 1986; 136: 408–409.PubMedGoogle Scholar
  34. 34.
    Prins GS, Ross LS. Properties of human epididymal sperm obtained from an alloplastic. Spermatoceles motility assessment and penetration of zona-free hamster oocytes in the presence and absence of caffeine. Fertil Steril 1985; 44: 401–404.PubMedGoogle Scholar
  35. 35.
    Marmar JL, De Benedictis TJ, Praiss DE. Clinical experience with an artificial spermatocele. JAndrol 1984; 5: 304–311.Google Scholar
  36. 36.
    Wagenknecht LV. Alloplastic spermatocele: 20 years experience and perspectives. Acta Chir Hung 1994; 34: 207–229.PubMedGoogle Scholar
  37. 37.
    Turner TT. On the development and use of alloplastic spermatoceles. Fertil Steril 1988; 49: 387–395.PubMedGoogle Scholar
  38. 38.
    Grantmyre JE, Thomas AJ, Falk RM, et al. Development of a new alloplastic spermatocele demonstrating successful sperm retrieval in an animal model. Fertil Steril 1995; 64: 179–184.PubMedGoogle Scholar
  39. 39.
    Moni VN, Lalitha PA. Moni’s window operation: a new surgical technique to create a sperm reservoir in congenital vasal agenesis. J Urol 1992; 148: 843–844.PubMedGoogle Scholar
  40. 40.
    Matthews GJ, Schlegel PN, Goldstein M. Microsurgical epididymal tubule marsupialization for creation of an autogenous tunica vaginalis sperm reservoir. In: Goldstein M, ed. Surgery of Male Infertility. Philadelphia: W.B. Saunders; 1995: 135–141.Google Scholar
  41. 41.
    Padron OF, Thomas AJ. Microsurgical correction of epididymal obstruction: epididymovasos-tomy. In: Lipshultz LI, ed. The Atlas of Urologie Clinics of North America. Philadelphia: W.B. Saunders; 1996.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Anthony J. ThomasJr.
  • Osvaldo F. Padron

There are no affiliations available

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