Microsurgical anastomosis
A duct with a diameter of about 3 mm with a lumen of 0.3–0.5 mm is sutured in two layers with threads as thick as a hair (9/0–10/0) under a magnification of 15–25×: first the mucosa with 6–8 sutures, then the muscle layer. Before stitching, fluid is taken from the proximal end: the presence of sperm confirms the patency of the epididymis; if they are not present, an anastomosis is performed with the epididymal tubule (epididymovasostomy). Through a 2–3 cm incision on the scrotum; absorbable sutures; swelling goes away in 1–2 weeks. Spermogram after 3, 6, 12 months.
Obstructive infertility
If the testicles produce sperm (normal testicular volume, normal FSH, spermatogenesis according to biopsy), but there are no sperm in the ejaculate, the reason is an obstruction in the vas deferens: after a vasectomy, previous epididymitis, trauma, surgery on the inguinal canal. Microsurgical reconstruction restores natural patency and allows conception without IVF; effectiveness depends on the level and duration of obstruction.
Results
After vasovasostomy, sperm appear in the ejaculate in 75–90% of men up to 10 years after vasectomy; pregnancy in couples occurs in 40–60%. After epididymovasostomy, patency is restored in 60–80%, pregnancy in 30–40%. If reconstruction fails or is not possible, sperm are obtained from the testicle (MESA/TESE) for IVF-ICSI; During surgery, the surgeon can prepare them for cryopreservation.
