Obstructions of the male reproductive tract: diagnosis and management

In this thesis several aspects of diagnosis and management of obstructive male infertility are discussed. The introduction gives a general overview of both male infertility and azoospermia. Diagnostic, genetic and therapeutic aspects of male infertility according to the current literature are discussed. The chapter on diagnosis of obstructions of the genital tract describes a study on the incidence and management of subtotal obstructions in men with severe oligozoospermia. Furthermore, genetic risk factors are investigated in tv.ro studies: in men with congenital bilateral absence of the vas deferens the relationship with cystic fibrosis is investigated and in men with either azoospermia or severe oligozoospermia cytogenetic abnormalities, Y chromosome deletions and cystic fibrosis gene mutations are determined. Practical advises for genetic investigations and genetic counselling are given. The chapter on management of male reproductive tract obstructions describes the results of transurethral resection of cystic lesions in the prostatic gland, causing ejaculatory duct obstruction. In a review on microsurgical treatment of the male genital tract, different operative techniques, outcome and prognostic factors are discussed extensively, including our own results. Finally. the technique of epididymal sperm extraction and intracytoplasmic sperm injection are presented together with the results of these combined treatments for men with irreparable obstructions of the seminal path. The scope of this thesis is to give an overview of recent developments in the diagnosis and treatment of obstructive male infertility, and to discuss the genetic risk factors associated with these forms of male infertility.

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