Surgical Correction of Epididymal Obstruction

Lee, Hee Young

Abstract

During the period of 1964 to 1972, epididymovasoetomies were performed on 53 cases of azoospermias due to epididymal obstruction. They were operated by the technics of the ordinary side-to-side epididymovasostomy with splint, in such a manner that a minute longitudinal opening in the vas was anastomosed to a similar opening in the epididymis at a site where live sperm had been recovered, which was applied on 58 per cent of the subjects, and of the buried side-to-side anastomosis with a splint, wherein longitudinally opened vas ..was actually buried in longitudinally opened head of epididymis, which was attempted on 26 per cent of them. The following data are presented as abstraction of clinical findings and the operation outcomes: l. An average age of the subjects was 35, and that of their wives, 30. 2. An average duration intervening between the beginning of the obstruction and the performance of the operation was 9 years. 3. An average frequency of sexual intercourse per week indicated 2.5 times before the obstruction 2. 2 times after the obstruction, and 2. 1 times after the operation. 4. In the majority of the cases, the post-inflammatory obstructions were found to be the most responsible causes for azoospermia in my present study. That is, non-tuberculous epididymitis (gonorrheal and non-gonorrheal origin) was found in 70 per cent of the subjects and tuberculous origin, 25 per cent of them respectively. 5. Success rate of non-tuberculous epididymitis group is higher than that of tuberculous epididymitis counter part 6. Success rate of the buried technic group is higher than that of the ordinary technic group. 7. Success rate of bilateral oozes with sperm group is higher than that of unilateral oozes with sperm or no oozes group. 8. A total of 53 cases was operated upon for curing the obstructive azooepermias. Poet-operative semen analyses were carried out on 43 cases out of the 53. Sperm appeared in the ejaculates of 17 cases out of the 43 in repeated sperm tests 3 weeks following the operation. Accordingly, successful operations were showed in 40 per cent of the 43 cases. Seven pregnancies(16%) followed the operation. 9. The writer believes that epididymovasostomy could be said to be a worthwhile procedure for the cases of asooapermia due to the obstruction of globus minor with normal spermatogenesis. The prognosis is always good whenever the indications are strictly followed.