Mobile epididymis. A new clinicopathologic entity in genesis of male infertility and its treatment by epididymopexy.

Mobile epididymis plays an important role in the genesis of male infertility. It constituted 9 percent of a consecutive series of idiopathic infertility. Of 200 patients examined (100 fertile and 100 infertile), mobile epididymis was detected in 9 infertile patients. The clinical picture is characteristic. Epididymis is widely separated from testicle and moves freely from side to side. Its body and tail are ill formed and the epididymovasal angle is obtuse. Azoospermia was persistent in 3 patients and intermittent in 6 patients. Testicular biopsy showed tubular dilatation. Epididymopexy was performed in the 9 patients to fix the epididymis to testicle: 3 patients showed improvement in semen quality with two resultant pregnancies. Failures were due to advanced testicular damage. Infertility in mobile epididymis appears to result from obstruction of efferent ductules, testicular ischemia, and/or interference with sperm maturation, transport, or delivery.