Algorithm for the surgical management of obstructive azoospermia ‘Shaeer's algorithm’ and the prevalence of multiple-site obstruction

Citation:
Shaeer, K., and O. Shaeer, "Algorithm for the surgical management of obstructive azoospermia ‘Shaeer's algorithm’ and the prevalence of multiple-site obstruction", Human Andrology, vol. 1, issue 1, pp. 17–21, 2011.

Abstract:

Aim: Evaluation of a protocol for the management of seminal tract obstruction.

Patients and methods: Eighty infertile men with obstructive azoospermia were enrolled in this study. Intraoperative vasography pinpointed the site (or sites) of obstruction. According to the algorithm, single-site or multiple-site obstructions were managed by various combinations of epididymovasostomy, vasovasostomy, transurethral resection of the ejaculatory ducts, and pelviscrotal vasovasostomy.

Results: Cases (92.5%, 74 out of 80 patients) showed the appearance of spermatozoa in semen after surgery. The average count was 14 million/ml and the average motility was 40%. Simultaneous multiple-site obstruction was detected and managed in 32 out of 80 patients (40%).

Conclusion: The modest success rate for surgical repair of seminal tract obstruction may be attributable to missing or failure to manage multiple-site obstruction, which appears to be common. The proposed algorithm guides the surgeon to full restoration of patency of the seminal tract along its whole length on the basis of proper diagnostic and corrective measures.