Comparison of Standard and Invagination Microscopic Epididymovasostomy Techniques for Idiopathic Epididymal Obstruction

UIO Ezeh and PJ Turek
Department of Urology, University of California San Francisco
San Francisco, CA

Background

Largely because of its simplicity, invagination epididymovasostomy has been used as an alternative to the standard end-to-side, mucosal-to-mucosal epididymovasostomy in vasectomy reversal for the last 5 years. However, its role in the management of more complex cases of obstructive azoospermia has not been established. We investigated the success of this technique in cases of idiopathic epididymal obstruction by comparing patency rates obtained with both the standard and invagination techniques in a consecutive series of infertility patients.

Objective

To compare epididymovasostomy patency rates achieved with two different surgical techniques performed by a single surgeon.

“…invagination epididymovasostomy provides equivalent, and possibly improved patency rates compared to standard epididymovasostomy in idiopathic obstructive azoospermia. ”
– Dr. Paul Turek

Design

Case-controlled, retrospective study of a consecutive series of men undergoing epididymovasostomy for idiopathic epididymal obstruction at a single institution.

Materials and methods

From a series of infertility patients who presented with idiopathic epididymal obstruction, we identified all men who underwent either the standard or invagination epididymovasostomy at the time of surgical exploration. Men with the diagnosis of congenital absence of the vas deferens were excluded from this analysis. Semen analyses were obtained initially at 6 weeks and then every 2 months in postoperative follow-up. Assessed outcomes included: time to patency postoperatively, patency rates (presence of spermatozoa in ejaculate), and functional patency rates (presence of motile spermatozoa in ejaculate).

Results

A total of 35 men underwent exploration and epididymovasostomy with either unilateral or bilateral procedures. The mean age of patients, the patency rates, and the time to patency are provided in the table below. The invagination cohort demonstrated a trend toward higher patency rates, and significantly shorter time to patency (P < 0.05) compared to the standard cohort. (See chart in downloadable PDF)

Conclusion

Similar to previous reports in cases of vasectomy reversal, our preliminary data on postoperative patency rates indicate that invagination epididymovasostomy provides equivalent, and possibly improved patency rates compared to standard epididymovasostomy in idiopathic obstructive azoospermia. In addition, mean time to sperm patency appears significantly shorter with the invagination method. We plan further follow-up in these patients to assess longer-term patency and pregnancy rates.

Standard and Invagination Microscopic Epididymovasostomy Techniques