Excluding vasectomies, obstructive azoospermia is most commonly due to bilateral obstruction of the epididymides
Causes of Epididymal obstruction
Vasoepididymostomy is considered the most technically challenging operation in male reproductive microsurgery.
The outcome of this procedure is highly dependent on the experience of the micro surgeon.
On physical examination fullness of epididymis in azoospermic patient is suggestive of epididymal obstruction.
With experienced microsurgeons post operative patency rate can be achieved in > 80% of patients.
Compared with vasovasostomy, the sperm concentration and sperm motility achievable with vasoepididymostomy tend to be lower, due to smaller size of the anastomosis.
Natural pregnancy rate around 30%