Objective: To investigate the application of microsurgical
technique in the preoperative diagnosis and therapeutic strategy
of obstructive azoospermia (OA).
Methods: 57 infertile patients were diagnosed as OA, and
percutaneous epididymal sperm aspiration, seminal plasma
fructose andα-glycosidase test, transrectal ultrasound were
undertaken and came to a preliminary diagnosis as epididymal
obstruction. Then they underwent scrotum exploration to
observed the obstruction of epididymis and vas deferens. The
patients that definitively diagnosed as epididymal obstruction
and live sperm was found in epididymal fluid during the
investigative surgery would undergo anastomosis of epididymis
to vas deferens; cases that sperm was not found until the
exploration was performed to the head of epididymis and vas
deferens obstruction with distal end in epididymis, and patients
with absence of vas deferens will undergo sperm aspiration
and freezing for intra-cytoplasmic sperm injection (ICSI). The
follow-up were performed for evaluate the effect.
Results: 53 patients (93%, 53/57) that underwent scrotal
exploration were diagnosed as epididymal obstructive azoospermia,
microsurgeries were carried out in 47 patients (82.5%, 47/57),
sperm aspiration and freezing were performed during operation in
10 cases (17.5%, 10/57). Live sperm were detected in semen in 22
cases (46.8%, 22/47) 1-18 months after micro-surgery; spouses
of 5 patients (10.6%, 5/47) underwent natural fertilization, and
successful pregnancy achieved by intracytoplasmic sperm injection
in spouses of 6 patients (18.5%, 6/32).
Conclusions: With microsurgical techniques become more
sophisticated, azoospermia patients should take several
non-invasive methods for diagnosis before operation.
Take obstructions in the vas deferens and epididymis into
consideration, scrotal exploration is needed for definitive
diagnosis. Microsurgical anastomosis technique or intraoperative
sperm aspiration and freezing may be a more economical
method should be promoted.