The Utilization of Fine Needle Vasography to Localize Obstruction of the Male Reproductive Tract.

OBJECTIVES: To report our experience using fine needle vasography (FNV) to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia.

METHODS: We report a multi-institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or cryptozoospermia, presence of palpable vasa, testicles ≥12 ml, and FSH <7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. FNV was performed using a 25-gauge angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR).

RESULTS: A total of 16 patients underwent vasography from 2014-2022 with three surgeons. Twelve patients presented with azoospermia, and four with cryptozoospermia. A total of 7 (44%) men were found to have distal obstruction on FNV. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis.

CONCLUSION: FNV is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia / cryptozoospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction (EDO) and other causes of blockage.