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Excerpt
The authors demonstrate that although following vaso-epididymostomy as many as 85% of men will have sperm in the ejaculate, there is a discrepancy in pregnancy rates, which are between 30% and 50%. To ascertain whether concomitant abnormalities in the prostate and seminal vesicle were responsible for this, the authors employed transrectal ultrasound to prospectively analyse the ejaculatory ducts and seminal vesicles of 40 men presenting with suspected epididymal or vasal obstruction (excluding post-vasectomy) and infertility. Ejaculatory duct dilatation was seen in 13/40 (33%) and 7/40 had either hypoplasia or dilatation of the seminal vesicle. Following vasography and epididymal exploration, 29 men were deemed to have epididymal obstruction and underwent vasoepididymostomy. For the 27 men with 6-month follow-up, patency and pregnancy rates were 75% and 22%, respectively. Mean sperm counts and percentage of motile sperm were significantly lower in the group with seminal vesicle or ejaculatory duct abnormalites (6.9 versus 43×106 sperm per ml and 1.2% versus 30%). Pregnancy was achieved in six of 19 cases with normal transrectal ultrasound and in none of eight cases with seminal vesicle or ejaculatory duct abnormalities. The authors conclude that transrectal ultrasound should be mandatory before attempted reconstruction.
