ABSTRACT

Hopps, Carin V. and Marc Goldstein. 2006. "Microsurgical reconstruction of iatrogenic injuries to the epididymis from hydrocelectomy," Journal of Urology 176(5): 2077–2080.

Purpose
We determined the feasibility and outcome of microsurgical reconstruction of the excurrent ductal tract in men with obstruction secondary to iatrogenic injury to the epididymis from hydrocelectomy.

Materials and methods
A retrospective chart review was done to identify men with iatrogenic injury to the epididymis or scrotal vas deferens and a history of hydrocelectomy. The outcome of microsurgical reconstruction was assessed by postoperative semen analysis. Pregnancy data were noted in patients actively attempting to conceive at a follow-up of six months or greater.

Results
Eight men were found to have iatrogenic injury to the epididymides (6) or scrotal vas deferens (2) due to previous hydrocelectomy. Injury was bilateral in four men and unilateral in four with contralateral testicular absence, dysfunction, or obstruction resulting from different etiologies, rendering all patients azoospermic. The mean obstructive interval was 16 years (range 6–32). Bilateral and unilateral vasoepididymostomy was performed in four and two men each, and crossed vasovasostomy was performed in two. Postoperative semen analysis data were available on six men. A patent microsurgical anastomosis was observed in five of six cases (83%). Four of the five men with patency had a follow-up of greater than six months, of whom three actively pursued conception. One pregnancy was achieved naturally and one was achieved by in vitro fertilization with intracytoplasmic sperm injection.

Conclusions
Hydrocelectomy may result in inadvertent injury to the excurrent ductal tract, causing obstruction and infertility. Microsurgical reconstruction results in the restoration of spermatozoa to the ejaculate in 83 percent of cases. The return of spermatozoa to the ejaculate may provide the couple with an opportunity to conceive naturally or through assisted reproduction.

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