title: [Diagnosis and treatment of epididymal obstructive azoospermia by microsurgery].
abstract: OBJECTIVE
  To investigate the diagnosis and treatment of epididymal obstructive azoospermia (OA) by microsurgery.
  
  
  METHODS
  We performed surgical scrotal exploration for 57 cases of OA whose obstruction was suspected to be in the epididymis. Those confirmed to be epididymal OA cases and with motile sperm in the epididymis underwent longitudinal-2-suture intussusceptive vasoepididymostomy (LIVES). And for those with sperm in the epididymal head only or with bilateral obstruction or absence of the vas deferens in the distal epididymis, the sperm were collected and subjected to cryopreservation for intracytoplasmic sperm injection (ICSI). After surgery, the patients were followed up for observation of the semen parameters and the rate of pregnancy.
  
  
  RESULTS
  Of the total number of patients, 53 (92.9%) were diagnosed with epididymal OA by scrotal exploration, 47 (82.5%) underwent microsurgery, and the other 10 (17.5%) received sperm cryopreservation. At 1 to 18 months after surgery, motile sperm were found in the ejaculate in 46.8% of the cases (22/47), natural pregnancy in 10.6% (5/47), and ICSI pregnancy in 18.5% (6/32).
  
  
  CONCLUSIONS
  With the development of microsurgery, non-invasive means should be the first choice for the diagnosis of OA. And surgical exploration can be employed to determine the location of obstruction and the option for treatment.
authors.affiliation: Department of Andrology, No. 181 Hospital of Chinese People's Liberation Army, Guilin, Guangxi 541002, China. llql@sina.com
authors.forename: Xue-De
authors.initials: XD
authors.lastname: Li
authors.forename: Qing-Xin
authors.initials: QX
authors.lastname: He
authors.forename: Sheng-Hai
authors.initials: SH
authors.lastname: Fan
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Jiang
authors.forename: Zhong-Xing
authors.initials: ZX
authors.lastname: Wang
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000175:diagnosis* / Q000601:surgery*; D004822:Epididymis / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D014649:Vas Deferens / Q000601:surgery