Feasibility of microsurgical reconstruction of the male reproductive tract after percutaneous epididymal sperm aspiration (PESA).

For obstructive azoospermia, surgical sperm retrieval from the epididymis for IVF/ICSI is an established management. However, various recent studies have established that surgical reconstruction with vasovasostomy or vasoepididymostomy remains a more cost-effective treatment option than upfront assisted reproduction. After epididymal sperm retrieval, fibrosis and scarring of the punctured epididymal tubule can lead to complete epididymal obstruction. The feasibility of surgical reconstruction after surgical epididymal sperm retrieval has not been established. We describe two cases of bilateral microsurgical vasoepididymostomy, using a new 2-suture longitudinal intussusception technique we previously described, after previous successful bilateral percutaneous epididymal sperm aspiration (PESA). In both cases, motile sperm were found in ejaculate in the first post-operative semen analysis at 6 weeks and 2 months. We conclude that even in men with previous epididymal sperm retrieval, surgical reconstruction remains a feasible management option for fertility.