Assistant Professor University of Florida College of Medicine
Introduction: Vasovasostomies are performed in the United States in approximately 6% of men who undergo a vasectomy for elective sterilization. Less commonly, vasal reconstruction may be performed, as in the case of acquired obstruction following inguinal hernia mesh placement or for congenital epididymal cysts. Herein, we discuss the operative management of a 41-year-old male with prior paternity and acquired azoospermia following bilateral hernia repairs with mesh.
Methods: The patient elected for bilateral vasal reconstruction as treatment of azoospermia following bilateral hernia mesh obstruction. Bilateral scrotal incisions were performed to evaluate the epididymes and testicles. A biopsy of the testicle confirmed spermatogenesis. Inguinal incisions were performed, and interrogation from the proximal epididymes suggested obstruction at the level of the inguinal ring. Laparoscopy was performed to free the abdominal vasa from tension. Laparoscopic trocars were placed to assist with delivery of the abdominal vas external to mesh obstruction. Vasovasostomies were then performed subinguinally through the previous inguinal incision to reestablish continuity of the vas deferens bilaterally.
Results: Bilateral vasovasostomies were performed distal to the inguinal ring through inguinal incisions. The patient's postoperative course was unremarkable. At 8 week follow-up, the patient had return of ejaculate to the sperm with a concentration of 25 million/ml, a total count of 100 million sperm, motility of 5%, and morphology of 5%.
Conclusions: Vasal reconstruction with bilateral vasovasostomies using laparoscopic assistance offers a method to return sperm to the ejaculate in patients with azoospermia following hernia repair with mesh obstruction. Low motility is not unexpected in the first few months following reconstruction.
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