Six men were found to have epididymal injury and 2 scrotal vasal injuries. 4 men underwent bilateral vasoepididymostomy and 2 unilateral vasoepididymostomy. 2 underwent crossed vasovasovasostomy. In six patients, semen analyses were available. 5 of those available had sperm in the ejaculate. One achieved spontaneous pregnancy. Two achieved pregnancy by IVF.

Editorial Comment:
The incidence of iatrogenic injury to the vas at the time of herniorraphy has been long acknowledged. We recently reported that the incidence of epididymal injury at time of hydrocelectomy was reported to be 5.6%. This paper points out the iatrogenic obstruction after hydrocelectomy required reconstructive anastomosis to the caput epididymis. This observation is important since the success of vasoepididymostomy, as determined by spontaneous conception rates, is well known to be dependent on the site of the anastomosis. In the current series only 1 of 6 (16.7%) or 1 of 8 (12.5%) for the intent to treat population patients achieved spontaneous pregnancy. Although the authors feel that their results support reconstruction in cases of iatrogenic epididymal injury, the fact that only 1 patient achieved a spontaneous pregnancy and 2 achieved a pregnancy with IVF would have to lead one to question whether iatrogenic injury to the epididymis can be more effectively treated utilizing percutaneous sperm acquisition techniques with IVF We must critically assess the widely held belief that reconstructive surgery is more effective than assisted reproductive technologies for all etiologies of obstructive azoospermia. That may be true for vasectomy reversal, but iatrogenic injury to the epididymis may be better approached with simpler, less costly and more effective techniques.

C.Hopper and M. Goldstein

J Urol 176(5):2077, 2006

Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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