Management of the epididymal tubule during an end-to-side vasoepididymostomy.

Microsurgical repairs of epididymal obstruction have improved because of specific tubule anastomoses. However, these techniques require considerable microsurgical skills and any modifications to organize and simplify these procedures seem desirable. Four modifications are described for the management of the epididymal tubule during end-to-side vasoepididymostomy, including closed tubule fixation, micro-tubulotomy, micro-suction and placement of double-armed sutures through the epididymal tubule before attachment of the vas. These procedures have been performed on 51 patients. "Mixed procedures," or a modified vasoepididymostomy on 1 side and a vasovasostomy on the other, were done in 32 cases and "pure procedures," which included bilateral modified end-to-side vasoepididymostomy (16) and unilateral procedures (3), were done in 19. The semen and pregnancy data for the 19 cases of pure procedures were patency rate 58% in 11 and pregnancy rate 42% in 8. These modifications appeared to be helpful to organize and simplify several aspects of the procedure, and the results were improved compared to other techniques.