After conventional vasoepididymostony, the epididymal lumen may become occluded or obstructed, resulting in recurring azoospermia. Recently, two-layer direct anastomosis has been advocated on the basis of experimental models of tubulovasostomy performed in rats. Monolateral tubulovasostomy was performed in four cases under 16-40 times magnification. Nylon or 11/0 Vycril was used as suture material for the internal layer of the anastomosis, and 10/0 Ethilon was used for the external layer. After three and six months, semen samples were evaluated for sperm count and motility. The presence of spermatozoa in all the samples confirmed 100% patency of the duct. Three patients had a number of spermatozoa compatible with fertility, and one pregnancy occurred.
