Vasoepididymostomy
is the
microsurgical
procedure for
treatment of
epididymal
obstruction.
It is the most
difficult
microsurgical
procedures for
the treatment
of male
infertility.
Surgeons must
have excellent
microsurgical
skills and
extensive
experience to
be able to
perform this
anastomosis
procedure
between the
vas deferens
and
epididymis.
What is
the etiology
of epididymal
obstruction?
The causes
of epididymal
obstruction
include:
Congenital
abnormalities:
absence of the
distal part of the
epididymis (cauda)
with absence of the
vas deferens.
Young's
Syndrome.
Infection or
inflammation:
history of
epididymitis
(tuberculosis or
chlamydia)
Iatrogenic
injury: accidental
injury from prior
surgery such as
hydrocele repair,
orchiopexy (for
Undescended
testes or torsion
or testis biopsy.
After
vasectomy.
What are the
advantages of
vasoepididymostomy?
The advantages of the
vasoepididymostomy for
treatment for the
epididymal obstruction
are:
Patients can
father their own
children through
natural
intercourse.
In vitro
fertilization (IVF)
with ICSI is a very
intense procedure
for the female
partner and very
costly. Also,
conception through
natural intercourse
does not pose
ethical issues and
it minimizes the
risk of multiple
births
substantially.
Return of sperm
rates (52% to 92%)
and pregnancy rates
(11% to 56%) are
competitive with
IVF/ICSI.
If an
experienced surgeon
performs the
microsurgical
procedure, the
results (patency
rate and pregnancy
rates) are better.
More importantly,
the actual overall
cost per live baby
is lower than the
IVF-ICSI related
procedure.
Insurance
companies may cover
the expense for
correction of an
epididymal
obstruction
Sperm can be
collected during
the procedure and
frozen (cryopreserved)
for future IVF/ICSI
attempts if the
microsurgical
procedure fails.
