The principal of treating obstructive azoospermia is to bypass the obstruction with surgical reconstruction in the excurrent ductal system whenever possible. The most common surgeries for excurrent ductal reconstruction are vasovasostomy (for vasal obstruction) and vasoepididymostomy (for epididymal obstruction). In cases where reconstruction is not feasible, as in most men who have a congenital absence of vas in which the gap defects are usually too large to bridge by reconstruction, surgical retrieval of sperm for assisted reproduction is a feasible treatment option. It should be pointed out, however, that various studies have established that surgical reconstruction is a more cost effective treatment than is upfront assisted reproduction. buy ortho tri-cyclen
Significant advances in microsurgical techniques have resulted in improved success rates for both vasovasostomy and vasoepididymostomy.
In addition to the vasa and epididymides, another common site of obstruction in the excurrent ductal system is the ejaculatory duct. Pathological conditions such as ductal compression by congenital midline cyst of the prostate and seminal vesicle ducts, and various inflammatory conditions involving the prostatic urethra are common etiologies of ejaculatory ductal obstruction. As stated previously, semen biochemical profiles can aid in the diagnosis of ejaculatory duct obstruction. Physical examination looking for palpable midline cysts on prostate examination or dilation of seminal vesicles is generally unyielding. The use of transrectal ultrasound, on the other hand, can reveal dilation of seminal vesicles and the presence of prostatic cysts, suggesting a diagnosis of ejaculatory duct obstruction. Diagnosis can also be confirmed on vasography, which should be done only intraoperatively, in the same setting of attempted reconstruction.