I. Traditional Chinese medicine treatment
According to TCM, obstructive azoospermia should be distinguished from deficiency and reality. The deficiency is mainly due to congenital endowment deficiency, kidney essence exhaustion, Qi and blood deficiency, similar to congenital bilateral vas deficiency; the actual is mainly due to stasis obstruction of the sperm duct, similar to acquired inflammatory obstruction. In deficient cases, herbal treatment is ineffective; in real cases, treatment is based on the principles of clearing heat and dampness, tonifying the kidneys and activating blood, and unblocking the sperm ducts.
1. Damp-heat downward injection evidence
Clinical manifestations: burning and astringent pain in the urine, frequent and urgent urination, yellow and short red urine, dripping after urination, perineal swelling and pain, dampness of the scrotum, dry mouth and bitterness, dry stools, yellow and greasy tongue coating, and other symptoms.
Treatment: Clearing heat and relieving dampness, clearing sperm and opening the orifice.
Radix: Gentian and liver diarrhea soup with addition and subtraction; gentian herb, scutellaria, gardenia, zedoary, psyllium angelica, raw groundnut, bupleurum, licorice.
2. Stasis of the meridians
Clinical manifestations: pain in the abdomen or chest, hidden pain in the testicles, astringent pain in urination, chest tightness, petechiae and petechiae on the tongue, etc.
Treatment: Invigorate blood circulation, resolve blood stasis, promote essence and tonify the kidney.
Radix Angelicae Sinensis, Radix et Rhizoma Peach, Radix et Rhizoma Safflower, Radix Paeoniae Alba, Radix Achyranthes Bidentatae, Rhizoma Chuanxiong, Fructus Lycii, Semen Cuscutae, Semen Psyllium, Radix Rehmanniae, Phellodendron, Glycyrrhiza Uralensis.
Second, Western medicine treatment
1.Intra-testicular obstruction
Testicular sperm extraction (TESE) or testicular sperm aspiration (TESA) is commonly used. The sperm obtained should be immediately used for intracytoplasmic sperm injection (ICSI) treatment or cryopreservation, and TESE or TESA is suitable for almost all obstructive azoospermia.
2. Epididymal obstruction
Congenital bilateral vas deferens (CBAVD) is commonly treated with percutaneous epididymal sperm aspiration (PESA) or microsurgical epididymal sperm aspiration (MESA) to obtain sperm, and the sperm obtained is usually used for ICSI treatment. Azoospermia caused by acquired acquired epididymal obstruction is feasible showing microsurgical epididymal vas deferens end-to-end or end-to-side-to-side anastomosis. Surgical reconstruction can be unilateral or bilateral; in general, bilateral reconstruction has a higher patency and pregnancy rate.
3.Proximal vas deferens obstruction
Proximal obstruction after vasectomy needs to show microsurgical vasectomy recanalization. Vasectomy-vasectomy anastomosis can only be used for a few patients, and the existence of secondary epididymal obstruction can be confirmed when no spermatozoa are detected in the postoperative vasectomy fluid, especially when there is toothpod-like mucus in the proximal vasectomy fluid, vasectomy-epididymal anastomosis should be performed.
4.Distal vas deferens obstruction
Extensive bilateral vas deferens loss due to injury from hernia or testicular descending fixation surgery during childhood is generally not reconstructable. In these cases, sperm should be extracted from the proximal vas deferens or TESE or MESA should be used for ICSI treatment. Extensive unilateral vas deferens loss with ipsilateral testicular atrophy can be considered for vas deferens anastomosis or vas deferens epididymal anastomosis with the contralateral side.
5.Ejaculatory duct obstruction
Ejaculatory duct obstruction can be tried by transurethral ejaculatory ductectomy. We can see through the different treatment methods of Chinese and Western medicine, for congenital causes of obstructive azoospermia Chinese medicine treatment usually has no obvious effect, should use Western medicine treatment; for acquired causes of obstructive especially inflammatory type obstruction can use Chinese medicine conservative treatment to reduce trauma and cost, Chinese medicine treatment effect is not good can further Western medicine surgery treatment.