The recent development of assisted reproductive technologies has greatly modified evaluation and treatment of infertility and reconstructive surgery has been challenged over recent years by IVF techniques in the case of obstructive azoospermia. Inguinal hernia repair is a frequent surgical procedure that may cause vas deferens obstruction. Polypropelene mesh induces an inflammatory reaction followed by a dense fibroblastic reaction surrounding the spermatic cord. Azoospermia secondary to mesh hernia repair is one of the most difficult cases for andrological reconstructive surgery. Up until now, open vasovasostomy has been the only available technique, but gives poor results. A new option called laparoscopic pelvi-scrotal vaso-vasostomy (PSVV) consists of mobilization of the endopelvic vas deferens from the deep inguinal ring to the superficial ring, allowing tension-free anastomosis with the distal part of the vas. The authors conclude that this technique is reliable, efficient and reproducible. It can be performed on both sides during the same procedure and it may open new possibilities for these patients to recover fertility and to father children naturally.
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