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  • Title: Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal.
    Author: Silber SJ.
    Journal: Fertil Steril; 1979 Mar; 31(3):309-15. PubMed ID: 437165.
    Abstract:
    Twenty-eight men undergoing vasectomy reversal who were found to have no sperm in the proximal vas fluid on one or both sides underwent microscopic epididymal exploration. In 33 of 39 cases so explored, normal sperm were found in the epididymal fluid of the corpus, despite absence of sperm in the vas fluid. Epididymal histology distal to this site revealed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scanty fluid. It is concluded that persistent azoospermia after an accurate microscopic vasovasostomy results from the secondary epididymal obstruction induced by rupture of the epididymal duct related to the pressure increase after vasectomy. 28 men underwent microscopic epididymal exploration and serial transections with biopsy. All of these men were noted to have no sperm in the vas fluid on the testicular side of the vasectomy site at the time of intended vasovasostomy. The age range of the patients was 27-55 years. All patients underwent several semen analyses preoperatively to determine that they were azoospermic. In 11 of these 28 patients the need for epididymal exploration was bilateral; in 17 the exploration was only unilateral. Thus, a total of 39 epididymides were examined. In 33 of the 39 cases, despite absence of sperm in the vas fluid, an abundance of sperm was noted in the epididymal fluid at some point between the junction of the tail of the epididymis with the corpus epididymidis and the area of the proximal corpus epididymidis. Epididymal histology distal to this site showed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scant fluid. Persistent azoospermia after an accurate microscopic vasovasostomy results from secondary epididymal obstruction induced by the rupture of the epididymal duct related to the pressure increase after vasectomy.
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