Objective: To evaluate the intraoperative factors affecting the patency of microsurgical vasoepididymostomy.
Methods: From January 2009 to July 2010, 73 men with obstructive azoospermia had undergone longitudinal intussusception vasoepididymostomy (LIVE). The mean age (range) was 31 years (23 to 48) for the patients and their mean infertility was 50.9 months (2 to 180). All the patients were included in three groups by the clinical variables in surgery: anastomosis number, anastomosis sites, epididymal fluid analysis. Bilateral and lateral anastomosis was in 50 and 23 cases, respectively. The anastomosis on caput, corpus and caudal was in 19, 46, and 8 cases respectively. Motile sperm in the epididymal fuild continuing flowage could be found in 55 patients. By contrast, immotile sperm could be found in 18 patients. Semen analysis was done at the end of 3 months, and patency was arbitrarily defined as >10 000 sperm/mL in ejaculate in at least one semen analysis after surgery.
Results: Of all the patients, 53 were followed up. Sperm was present in the ejaculate in 38 patients postoperatively. The overall patency rate was 71.7% (38/53). Patency rates of bilateral surgery and of lateral surgery achieved 80.7% and 27.6%; of caput anastomosis 38.5%, of corpus anastomosis 78.8%, of caudal anastomosis 100%, of motile sperm with epididymal fluid continuing flowage 83.7% and of immotile sperm 40%, respectively. In the study, 17 patients (33.3%, 17/53) reported spontaneous pregnancy.
Conclusion: Except for microsurgical technology, bilateral anastomosis, corpus or caudal anastomosis, and motile sperm with epididymal fluid continuing flowage may improve patency rate postoperatively.