[Surgical therapy of obstructive azoospermia: microsurgery].
Microscopic procedures for therapy of obstructive azoospermia or of vasectomy reversals have resulted in accurate reapproximation of ductal structures. The success of vasovasostomy appears to be influenced by the length of time that has passed since the vasectomy was performed or the obstruction become. Failures of vasovasostomy may be attributed to anastomotic stenosis, sperm antibodies, epididymal dysfunction, or an unrecognized epididymal tubule blowout with subsequent obstruction. The latter condition should by suspected when, at the time of the initial vasovasostomy, there is lack of fluid containing spermatozoa in the cut end of the testicular portion of the vas. Chronic intratubular pressure may cause an epididymal blowout, with subsequent spermatic granuloma and obstruction in the epididymal tubule, that may also be related to a congenital disorder or a postinflammatory condition. Spermatozoa gain maturation and the capacity for motility as they move from the caput to the cauda of the epididymis as possible. Microsurgery allows direct microtubular anastomosis between the epididymal tubule and the cut end of the vas. Some conditions are not amenable to conventional surgical techniques, such obstructed azoospermia due to congenital bilateral absence of the vas deferens or to severe damage to the reproductive ducts. To treat these patients surgeons have devised reservoirs (artificial spermatoceles) to collect spermatozoa to be used for artificial insemination. An alternative treatment method for obstructed azoospermia is to obtain sperm from the epididymis with the use of an operating microscope. Although sperm have been obtained the poor sperm motility requires either in vitro fertilization or GIFT. The technique looks promising, although improved techniques to enhance the motility of the collected sperm will ultimately yield better results.