Microsurgical treatment of obstructive azoospermia: Yet current in the PMA ERA? Results of a multicenter study

Aim of the Study: In male infertility, the current challenge is to properly reconcile new and old techniques taking into account costbenefit and scientific evidence for both. The aim of our work was to evaluate if microsurgical reconstruction of the seminal pathway in patients with proximal obstruction can still be considered an effective treatment for infertile men suffering from obstructive azoospermia in the light of new medically assisted procreation techniques. Materials and Methods: From 1995 to 2016, at the Urological Clinic of the University of Trieste and the University College London Hospital (UCLH), 242 patients with obstructive azoospermia underwent microsurgical treatment of recanalization of the seminal pathways. Among these patients, 161 patients underwent Vasoepididimostomy (EDV), 72 at vasovasostomy (VV) and 9 at VV + EDV. The average age was 41 (±7.9). Patients were subdivided according to the type of microsurgical reconstruction performed. Patients previously undergoing unsuccessful attempts at microsurgical reconstruction, patients with infertile or poorly motivated female partners to have a child and patients undergoing recanalization after retention pain vasectomy were excluded from the study. The primary objective of the study was to evaluate the rate of patency of the seminal pathways and the pregnancy rate. Results: In patients undergoing EDV and VV, the success rate in terms of patency of the anastomosis was 75% and 42%, respectively, while the pregnancy rate of 55% and 13%. The patency of the cumulative anastomosis was 48% (109/185) and the general pregnancy rate of 19% (30/161). In the 92 patients who underwent “vasectomy reversal” the mean time interval between vasectomy and microsurgical reconstruction (IT) was 12.2 years (SD: 12.2 ± 6.41; 1–27). In this category of patients the results were inversely proportional to the average time spent by vasectomy. Discussion: According to the literature, our results confirm that microsurgical reconstruction of the seminal pathways remains a valid therapeutic option with an excellent cost/benefit ratio in patients with obstructive azoospermia. The best results are in previously vasectomized patients and are inversely proportional to the time elapsed.