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Chapter 22 - Surgery to Improve Sperm Delivery

from Section 4 - Treatment of Male Infertility

Published online by Cambridge University Press:  08 July 2023

By
Saneal Rajanahally ,
Larry I. Lipshultz ,
Alexander W. Pastuszak ,
Danielle Velez  and
Craig S. Niederberger
Edited by
Larry I. Lipshultz ,
Stuart S. Howards ,
Craig S. Niederberger  and
Dolores J. Lamb
Larry I. Lipshultz
Affiliation:
Baylor College of Medicine, Texas
Stuart S. Howards
Affiliation:
University of Virginia
Craig S. Niederberger
Affiliation:
University of Illinois, Chicago
Dolores J. Lamb
Affiliation:
Weill Cornell Medical College, New York
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Summary

Successful transportation of sperm from their origin within the seminiferous tubules of the testis to their site of emission in the posterior urethra involves a completely patent ductal system. Emerging from the testis into the efferent ducts, sperm enter 6–7 m of the coiled epididymal tubule, which develops into the convoluted vas deferens. The convoluted vas then gradually straightens as it courses up the scrotum, progressing first through the external ring of the inguinal canal, before diving into the retroperitoneum via the internal inguinal ring. Sperm within the vas will ultimately fill the widened ampulla of the vas and join with the seminal vesicle (SV) duct (approximately 2 cm in length) to form the ejaculatory duct (ED) that courses through the prostate. Obstruction can occur anywhere along this ductal system. This chapter will focus on the three most common sites of obstruction: the ED; the vas deferens; and the epididymis. The discussion will begin distally at the ED and progress proximally towards the testis.

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Infertility in the Male , pp. 413 - 436
Publisher: Cambridge University Press
Print publication year: 2023

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