[Microsurgical vasovasostomy and epididymovasostomy for seminal tract obstruction: cause of obstruction and operative outcome].

The surgical outcome in 42 patients with seminal tract obstruction who underwent microsurgical vasovasostomy or epididymovasostomy and were followed up for more than 3 months postoperatively is reported. Causes of the obstruction were vasectomy in 7 patients, childhood inguinal herniorrhaphy in 15, epididymitis in 5, Young's syndrome in 3 and others in 12. Twenty-eight patients had bilateral obstruction while 14 had unilateral obstruction. After 51 operations, including 11 reoperation in 9 patients, the anastomosis was patent in 83.3%, semen quality normalized in 21.4% and pregnancy was achieved in 31.0% of the 42 patients. Success rate of vasovasostomy and epididymovasostomy was 57.7% and 78.3%, respectively. Factors detrimentally affecting the operative outcome were obstruction due to Young's syndrome, obstruction for more than 10 years, absence of sperm in vasal fluid during the operation, elevated serum FSH levels and presence of seminal tract anomaly. Presence of serum antisperm antibodies had no effect on pregnancy rate. Microsurgical reanastomosis of the seminal tract resulted in restoration of fertility in many patients with seminal tract obstruction who had normal testicular spermatogenesis.