Microsurgery in andrologic urology. I. Refertilization.

Of 30,000 men examined for impaired fertility from 1964 to the present, 900 were diagnosed as having excretory azoospermia. Of this number, 465 underwent surgery. Epididymovasostomy was performed on 316 men. For 11 years, this surgery was done with surgical loupes, and a patency rate of 48% was achieved in those men undergoing bilateral epididymovasostomy. (Only 52% of our patients showed inflammatory obstruction.) In a small series of patients undergoing the procedure under the operating microscope, a patency rate of 75% was achieved. Vasovasostomy was performed in 20 patients with loupes and splints. Patency was obtained in 11 of the 17 that were followed. Ten of 12 patients receiving anastomosis by a technique placing nonabsorbable sutures through the entire wall of the vas became fertile. Nine of 10 patients who were operated on by a double-layer technique under the operating microscope were found to have patent ducts at follow-up. The advances in microsurgical techniques, equipment, and suture materials have considerably improved the changes for refertilization.