Microsurgical Single Tubular Epididymovasostomy Assessment In Era of Intracytoplasmic Sperm Injection

Kim, Soo Woong; Yun, Jong Min; Paick, Jae Seung

Abstract

In the situations that intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility, there appeared some needs to evaluate the role of microsurgical single tubular epididymovasostomy (EV). The outcome of microsurgical single tubular EV for obstructive azoospermia patients was retrospectively reviewed in 61 patients who had been followed for more than 18 months postoperatively. The overall patency rate followed surgery was 69% (42/61 patients), and live-birth rate was 31% (19/61 patients). Of these 19 men 13 were able to impregnate their partners; 6 of the 19 live-birth were achieved with the assistance of conventional IVF. Previously known prognostic factors-etiology, preoperative testis biopsy findings and intraoperative presence of sperm or motile sperm- all did not affect the patency and pregnancy rate. The live-birth rate of ICSI has been reported about 20~40%. Our results suggest that microsurgical single tubular EV is the preferential method to treat obstructive azoospermia patients concerning the merits of natural pregnancy and high patency rate. ICSI would be applied to the patients with patent anastomoses who have failed to achieve natural pregnancy. We think that microsurgical single tubular EV in obstructive azoospermia patients should be performed more actively by well-trained urologists in more expanded indications.