Repeat epididymovasostomies: are they worthwhile?
OBJECTIVE
To establish whether it is worthwhile repeating epididymovasostomy in men with persistent obstructive azoospermia.


METHODS
The study included 24 men with obstructive azoospermia, persisting after previous surgery for blockage in the body or tail of the epididymes, who underwent repeat epididymovasostomy proximal to the previous anastomoses. Semen was re-analysed after 6 and 12 months, and information about pregnancy self-reported or determined by postal survey.


RESULTS
The postoperative sperm concentration was >107 /mL in 15 patients (62%) and 10 female partners became pregnant (41%). Antisperm antibodies were present in nine patients and three of their partners became pregnant after the man received steroid therapy. Unilateral revision did not produce a favourable outcome.


CONCLUSIONS
Having defined a favourable group of men with obstructive azoospermia by scrotal exploration, i.e. those with caudal epididymal blocks and patent vasa deferentia, initial technical failure should not preclude surgical revision of the anastomoses in selected cases.
Nigam
A K
AK
Department of Urology, St Bartholomew's Hospital, West Smithfield, London, UK.
Hendry
W F
WF
D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009845:Oligospermia / Q000601:surgery*; D011247:Pregnancy / Q000706:statistics & numerical data*; D012086:Reoperation; D012189:Retrospective Studies; D013076:Sperm Count; D013519:Urogenital Surgical Procedures / Q000379:methods*