Vasoepididymostomy

The causes of epididymal obstruction include:

• Congenital abnormalities: absence of the distal part of the epididymis (cauda) with absence of the vas deferens.
• Young’s Syndrome.
• Infection or inflammation: history of epididymitis (tuberculosis or chlamydia)
• Iatrogenic injury: accidental injury from prior surgery such as hydrocele repair, orchiopexy (for undescended testes or torsion or testis biopsy)
• After vasectomy.

The advantages of the vasoepididymostomy for treatment for the epididymal obstruction are:

• Patients can father their own children through natural intercourse.
• In vitro fertilization (IVF) with ICSI is a very intense procedure for the female partner and very costly. Also, conception through natural intercourse does not pose ethical issues and it minimizes the risk of multiple births substantially.
• Return of sperm rates (52% to 92%) and pregnancy rates (11% to 56%) are competitive with IVF/ICSI.
• If an experienced surgeon performs the microsurgical procedure, the results (patency rate and pregnancy rates) are better. More importantly, the actual overall cost per live baby is lower than the IVF-ICSI related procedure.
• Insurance companies may cover the expense for correction of an epididymal obstruction
• Sperm can be collected during the procedure and frozen (cryopreserved) for future IVF/ICSI attempts if the microsurgical procedure fails.