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Xiao H, Zhou S, Chen Q, Ding Y, Yang P, Huang H, Chen X, Zhou H, Tang S. Comparative evaluation of double- and single-armed two-suture longitudinal intussusception techniques in microsurgical vasoepididymostomy: An updated systematic review and meta-analysis. PLoS One 2024; 19:e0298019. [PMID: 38315686 PMCID: PMC10843031 DOI: 10.1371/journal.pone.0298019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates. METHODS Data from patients with EOA who underwent two-suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random-effects model, and weighted mean differences were reported. RESULTS A total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63-72%), with a patency time of approximately 4.63 months (95% CI: 4.15-5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31-46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double-armed and single-armed LIVE techniques. CONCLUSION The single-armed LIVE is a potential alternative surgical option when high quality double-needle sutures are not easily accessible.
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Affiliation(s)
- Hong Xiao
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shan Zhou
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yilang Ding
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peng Yang
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hailin Huang
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xi Chen
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huiliang Zhou
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Songxi Tang
- Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Wan B, Wu Y, Wu Z, Zhou Z, Lu W. Current progress on the curative effects of vasoepididymostomy for patients with obstructive azoospermia: An updated systematic review and meta-analysis of human studies. Andrology 2023; 11:103-111. [PMID: 36116029 DOI: 10.1111/andr.13300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/17/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstructive azoospermia (OA) is an important cause of male infertility, and epididymal OA (EOA) is a common disease. Microsurgical reconstruction is a common technique used in the treatment of EOA. In the present study, we analyzed the effectiveness of microsurgical vasoepididymostomy (MVE) at different levels and compared the differences among several MVE techniques. MATERIALS AND METHODS A literature search was conducted in the PubMed, Web of Science, and Embase databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies were published in English until May 14, 2021. The R 4.1.2 software was utilized to evaluate the event rate, risk ratio (RR), and 95% confidence interval (CI). RESULTS A total of 51 studies involving 2853 patients with OA were included in our meta-analysis. The overall mean patency rate of patients who underwent MVE was 67.20% (95% [CI]:63.30%-71.10%), and the overall mean natural pregnancy rate of their partners was 40.05% (95% [CI]: 35.30%-45.60%). The pooled results showed that the patency rate of bilateral MVE was higher than that of unilateral MVE (RR = 1.42; 95% [CI]:1.25-1.61; p < 0.00). A comparison of the anastomotic site of MVE showed that the caudal/corpus area was favorable for the patency rate (RR = 1.17; 95% [CI]:1.04 - 1.32; p < 0.00). The caudal area was also advantageous for the patency rate (RR = 1.20; 95% CI:1.03 - 1.41; p < 0.04). Compared with typical MVE (65.20%, 95% [CI]:61.40%-69.10%), deferential vessel-sparing MVE with a higher overall mean patency rate (83.60%, 95% [CI]:75.40%-91.70%). CONCLUSIONS The meta-analyses indicated that MVE is a high- and cost-effective therapeutic method for patients with EOA, and deferential vessel-sparing MVE could be mainstream in the near future.
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Affiliation(s)
- Bangbei Wan
- Department of Andrology, Hainan Women and Children's Medical Centre, Haikou, China.,Reproductive Medical Center, Hainan Women and Children's Medical Centre, Haikou, China.,Department of Urology, Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital, Haikou, China.,Department of Pharmacology, Hainan Medical University, Haikou, China
| | - Yamei Wu
- Reproductive Medical Center, Hainan Women and Children's Medical Centre, Haikou, China
| | - Zhong Wu
- Department of Andrology, Hainan Women and Children's Medical Centre, Haikou, China
| | - Zhi Zhou
- Reproductive Medical Center, Hainan Women and Children's Medical Centre, Haikou, China
| | - Weiying Lu
- Reproductive Medical Center, Hainan Women and Children's Medical Centre, Haikou, China
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Punjani N, Kang C, Lee RK, Goldstein M, Li PS. Technological Advancements in Male Infertility Microsurgery. J Clin Med 2021; 10:jcm10184259. [PMID: 34575370 PMCID: PMC8471566 DOI: 10.3390/jcm10184259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
There have been significant advancements in male infertility microsurgery over time, and there continues to be significant promise for new and emerging techniques, technologies, and methodologies. In this review, we discuss the history of male infertility and the evolution of microsurgery, the essential role of education and training in male infertility microsurgery, and new technologies in this space. We also review the potentially important role of artificial intelligence (AI) in male infertility and microsurgery.
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Affiliation(s)
- Nahid Punjani
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (N.P.); (C.K.); (M.G.)
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA;
| | - Caroline Kang
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (N.P.); (C.K.); (M.G.)
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA;
| | - Richard K. Lee
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA;
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (N.P.); (C.K.); (M.G.)
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA;
| | - Philip S. Li
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (N.P.); (C.K.); (M.G.)
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA;
- Correspondence:
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Li P, Liu N, Zhi E, Yao C, Chen H, Tian R, Huang Y, Zhao L, Yang C, Zhao J, Shi C, Liu M, Wang B, Chen H, Li Z, Xia S. Vasal vessel-sparing microsurgical single-armed vasoepididymostomy to epididymal obstructive azoospermia: A retrospective control study. Andrologia 2021; 53:e14133. [PMID: 34260106 DOI: 10.1111/and.14133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/29/2022] Open
Abstract
This study aimed to evaluate the efficacy and safety of vasal vessel-sparing modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE) to epididymal obstructive azoospermia patients. Forty consecutive epididymal obstructive azoospermia cases, who underwent microsurgical vasoepididymostomy in Shanghai General Hospital from January 2019 to October 2019, were included in this study. Twenty cases underwent SA-LIVE (group A), and 20 cases underwent vasal vessel-sparing SA-LIVE (group B). Until March 2021, the mean follow-up period was 16.9 ± 4.1 (12-23) months. The overall patency rate was 82.5%, and 80% and 85% for group A and group B respectively. The mean time to achieve patency was 4.11 ± 2.74 months. The overall natural pregnancy rate was 51.5%(17/33) at the mean follow-up of 16.9 months. The natural pregnancy rate was 50.0% for group A and 52.9% for group B (p > .05). At the time of 6 months post-operation, the patency rate was 70% for group A and 80% for group B (p = .465); the natural pregnancy rate was 0% for group A and 31.3% for group B (p = .022). Vasal vessel-sparing SA-LIVE is safe and effective to achieve favourable patency and pregnancy rates. Preserving vasal vessel would improve natural pregnancy rate at a very early stage.
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Affiliation(s)
- Peng Li
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nachuan Liu
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Erlei Zhi
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chencheng Yao
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huixing Chen
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruhui Tian
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuhua Huang
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Liangyu Zhao
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chao Yang
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingpeng Zhao
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chenkun Shi
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Liu
- Department of Urology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Bo Wang
- Department of Urology, The Second Hospital in Weinan, Weinan, China
| | - Huirong Chen
- Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Li
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shujie Xia
- Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Andrology, The Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Li P, Liu NC, Zhi EL, Yao CC, Zhao ZL, Yu ZY, Li QM, Huang YH, Ju JC, Huang WB, Rozi H, Ji ZY, Guo SW, Tian RH, Li Z. 3D digital image microscope system-assisted vasovasostomy and vasoepididymostomy in rats. Asian J Androl 2021; 23:396-399. [PMID: 33565428 PMCID: PMC8269826 DOI: 10.4103/aja.aja_94_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Optimal vision and ergonomics are essential factors contributing to the achievement of good results during microsurgery. The three-dimensional (3D) digital image microscope system with a better 3D depth of field can release strain on the surgeon's neck and back, which can improve outcomes in microsurgery. We report a randomized prospective study of vasoepididymostomy and vasovasostomy using a 3D digital image microscope system (3D-DIM) in rats. A total of 16 adult male rats were randomly divided into two groups of 8 each: the standard operating microscope (SOM) group and the 3D-DIM group. The outcomes measured included the operative time, real-time postoperative mechanical patency, and anastomosis leakage. Furthermore, a user-friendly microscope score was designed to evaluate the ergonomic design and equipment characteristics of the microscope. There were no differences in operative time between the two groups. The real-time postoperative mechanical patency rates were 100.0% for both groups. The percentage of vasoepididymostomy anastomosis leakage was 16.7% in the SOM group and 25.0% in the 3D-DIM group; however, no vasovasostomy anastomosis leakage was found in either group. In terms of the ergonomic design, the 3D-DIM group obtained better scores based on the surgeon's feelings; in terms of the equipment characteristics, the 3D-DIM group had lower scores for clarity and higher scores for flexibility and adaptivity. Based on our randomized prospective study in a rat model, we believe that the 3D-DIM can improve surgeon comfort without compromising outcomes in male infertility reconstructive microsurgery, so the 3D-DIM might be widely used in the future.
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Affiliation(s)
- Peng Li
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Na-Chuan Liu
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Er-Lei Zhi
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Chen-Cheng Yao
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Zhi-Liang Zhao
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China
| | - Zhi-Yong Yu
- Weifang Traditional Chinese Hospital, Weifang 250200, China
| | - Qi-Meng Li
- The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yu-Hua Huang
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jie-Chang Ju
- Zhengzhou Central Hospital Affiliated with Zhengzhou University, Zhengzhou 450007, China
| | - Wen-Bin Huang
- Wenzhou Integrated Traditional Chinese, Wenzhou 325000, China
| | - Husanjan Rozi
- Kashgar District Second People's Hospital, Kashgar 844000, China
| | - Zhi-Yong Ji
- Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China
| | - San-Wei Guo
- Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Ru-Hui Tian
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Zheng Li
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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6
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Yuan Y, Fang D, Lei H, Li M, Cheng W, Gao B, Peng J, Zhang Z, Xin Z, Guo Y. Rat model and validation of a modified single-armed suture technique for microsurgical vasoepididymostomy: Guo's SA-LIVE. Andrology 2021; 9:361-367. [PMID: 32779882 DOI: 10.1111/andr.12885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/18/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Double-armed suture longitudinal intussusception vasoepididymostomy (DA-LIVE) has been widely adopted owing to its simplicity and high success rate; however, specialized double-armed microsutures are required. OBJECTIVE To provide a novel single-armed suture longitudinal intussusception vasoepididymostomy (SA-LIVE) technique using only two single-armed sutures, named Guo's SA-LIVE. MATERIALS AND METHODS Four weeks after vasectomy in male adult Wistar rats, vasoepididymostomies were performed using DA-LIVE, SA-LIVE, or Guo's SA-LIVE. After 12 weeks, functional patency was functionally assessed by evaluating for motile spermatozoa distal to the anastomosis. If no motile spermatozoa were visible, the mechanical patency of the anastomosis was tested by the ability of methylene blue to pass through the surgical anastomosis. The key procedure in Guo's SA-LIVE was cutting each needle with over 1cm attaching suture and making a flat overhand bend knot to tie the needle to the other end of the suture, after the needles were passed through the epididymal tubule and then the vasal lumen in an inside-out fashion, and then, the needles were passed through the vasal lumen in an inside-out fashion. RESULTS The proportions of functional patency were 50.0% (3/6), 33.3% (2/6), and 50% (3/6) for the DA-LIVE, SA-LIVE, and Guo's SA-LIVE groups, respectively (P = .799). The proportions of mechanical plus functional patency for the three methods were 83.3% (5/6), 66.7% (4/6), and 83.3% (5/6), respectively (P = .725). The mean anastomosis times for the three LIVE techniques and the proportions of complications were similar (P = .150 and .758, respectively). CONCLUSIONS Guo's single-armed suture technique is a potentially effective alternative to perform vasoepididymostomy when specialized double-armed microsutures are not available based on the current animal experiment.
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Affiliation(s)
- Yiming Yuan
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Dong Fang
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Hongen Lei
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
- Department of Urology, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Meng Li
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Wanjun Cheng
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
- Andrology Department, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Bing Gao
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Jing Peng
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Zhichao Zhang
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Zhongcheng Xin
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Yinglu Guo
- Andrology Center, Peking University First Hospital, Beijing, China
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
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Shiraishi K, Matsuyama H. Outcomes of partial intussusception and endo-to-side vasoepididymostomy in men with epididymal obstructive azoospermia. Int J Urol 2020; 27:1124-1129. [PMID: 32914440 DOI: 10.1111/iju.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Vasoepididymostomy is an ideal surgical approach for epididymal obstructive azoospermia. The aim of the present study was to compare reproductive outcomes of vasoepididymostomy with several anastomotic techniques, including end-to-side and longitudinal intussusception vasoepididymostomy, and partial intussusception and endo-to-side vasoepididymostomy. METHODS A case-control study including 110 infertile men with epididymal obstructive azoospermia with mean age of 35 years was carried out. Univariate and multivariate analyses using clinical factors were carried out to predict patency and non-assisted reproductive technology pregnancy. Johnsen score count and proliferating cell nuclear antigen expression were used as surrogates for spermatogenic function. Operative time, number of 10-0 sutures and late failure rates were also compared. RESULTS The overall patency and non-assisted reproductive technology pregnancy rates were 70% and 32%, respectively. Multivariate analyses showed that the presence of motile sperm in the epididymis and a higher spermatogenic function (P < 0.05) were independent predictors for patency, and that a higher spermatogenic function and anastomosis at the caput/corpus (P < 0.001) were predictors for non-assisted reproductive technology pregnancy. The operative time was significantly shorter with partial intussusception and endo-to-side than with the other techniques (P < 0.001), and the number of 10-0 sutures was significantly less with partial intussusception and endo-to-side than with longitudinal intussusception vasoepididymostomy (P < 0.01). CONCLUSIONS Partial intussusception and endo-to-side as well as end-to-side and longitudinal intussusception vasoepididymostomy are feasible vasoepididymostomy techniques for epididymal obstruction. Spermatogenic function plays important roles in patency and non-assisted reproductive technology pregnancy after vasoepididymostomy. Depending on the surgeon's expertise, partial intussusception and endo-to-side provides similar functional outcomes to those of more established vasoepididymostomy techniques, such as end-to-side and longitudinal intussusception vasoepididymostomy, and it could therefore be considered an effective technique for seminal reconstruction in patients with epididymal obstructive azoospermia.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Liu N, Li P, Zhi E, Yao C, Yang C, Zhao L, Tian R, Chen H, Huang Y, Yu Y, Li Z. A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration. BMC Urol 2020; 20:121. [PMID: 32787873 PMCID: PMC7424978 DOI: 10.1186/s12894-020-00692-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/04/2020] [Indexed: 11/14/2022] Open
Abstract
Background To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3–36) months. Results Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9, 40.7, 36.4, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11 ± 2.74 months. In the first 6 months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3–36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis. Conclusion Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within 1 year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.
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Affiliation(s)
- Nachuan Liu
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Peng Li
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Erlei Zhi
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Chencheng Yao
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Chao Yang
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Liangyu Zhao
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Ruhui Tian
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Huixing Chen
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Yuhua Huang
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Yuexin Yu
- Anhui Medical University, Hefei, 230032, China
| | - Zheng Li
- Department of Andrology, the Center for Men's Health, Urologic Medical Center, Shanghai Key Laboratory of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China.
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Shimpi RK, Raval KV, Patel DN. Modification of microsurgical longitudinal intussusception technique of vaso-epididymal anastomosis: A single-center experience. Urol Ann 2019; 11:374-379. [PMID: 31649456 PMCID: PMC6798286 DOI: 10.4103/ua.ua_90_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Microsurgical intussusception vasoepididymostomy (VE) is well-established treatment option for obstructive azoospermia due to epididymal obstruction. In this study, we evaluated patency rates and complications of our modified longitudinal intussusception technique of microsurgical VE. We have modified the intussusception technique by taking only adventitia of epididymal tubule. Methods This was a prospective, single-center (tertiary care center) study conducted from February 2008 to January 2016. Study patients were men aged more than 18 years with infertility due to azoospermia. All participants underwent microscopic VE with our modified intussusception technique. Patency rates, complications, and improvement in semen quality were assessed. Results A total of 42 patients were included in the study and underwent unilateral VE using longitudinal intussusceptions technique. The mean age of the patients was 30.21 years. Of these 42 patients, 40 patients had congenital obstruction. Average operative time was 130.42 min. A total of 36 (85.7%) patients had motile sperms in the epididymal fluid. Patency at 3 months was observed in 25 (62.5%) patients with an average sperm count of 17.1 million/mL. Only two patients (5%) had hemotoma at the site of surgery. Conclusion Our modified technique of microsurgical longitudinal intussusception VE using epididymal adventitial stitch showed a reasonable patency rate after surgery.
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Affiliation(s)
- Rajendra K Shimpi
- Department of Urology and Genito-Urinary Surgery, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Krutik V Raval
- Department of Urology and Genito-Urinary Surgery, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Darshan N Patel
- Department of Urology and Genito-Urinary Surgery, Ruby Hall Clinic, Pune, Maharashtra, India
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Lyu KL, Zhuang JT, Li PS, Gao Y, Zhao L, Zhang YD, Zhou MK, Yu JW, Feng X, Sun XZ, Deng CH, Tu XA. A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy. Asian J Androl 2019; 20:576-580. [PMID: 29974884 PMCID: PMC6219301 DOI: 10.4103/aja.aja_46_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Microsurgical longitudinal intussusception vasoepididymostomy (LIVE) has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine (85.5%, 59/69) men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis (>10 000 sperm/ml) in 83.1% (49/59) of men. The natural pregnancy rate was 40.7% (24/59) by the end of the study, with 87.5% (21/24) of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.
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Affiliation(s)
- Kun-Long Lyu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China.,Department of Urology and Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Jin-Tao Zhuang
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Philip S Li
- Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA
| | - Yong Gao
- Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Liang Zhao
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Ya-Dong Zhang
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Ming-Kuan Zhou
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Jing-Wei Yu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Xin Feng
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Xiang-Zhou Sun
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Chun-Hua Deng
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
| | - Xiang-An Tu
- Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China
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Hayden RP, Li PS, Goldstein M. Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation. Fertil Steril 2019; 111:444-453. [DOI: 10.1016/j.fertnstert.2019.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 02/06/2023]
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Chen XF, Chen B, Liu W, Huang YP, Wang HX, Huang YR, Ping P. Microsurgical vasoepididymostomy for patients with infectious obstructive azoospermia: cause, outcome, and associated factors. Asian J Androl 2017; 18:759-62. [PMID: 26924282 PMCID: PMC5000800 DOI: 10.4103/1008-682x.175095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Azoospermia is of great importance to male infertility. Obstructive azoospermia (OA) due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy (VE) and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone (FSH), and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ± 3.9 years (range 22–38), with average follow-up being 16.5 ± 5.9 months (range 4–28). According to the 150 cases being followed after VE procedures, the total patency rate was 72% (108/150). During follow-up, 38.7% (58/150) natural pregnancies occurred, with overall live birth rate being 32.7% (49/150). Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.
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Affiliation(s)
- Xiang-Feng Chen
- Center for Reproductive Medicine, Shanghai Human Sperm Bank, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135; Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127; Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Bin Chen
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Wei Liu
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yan-Ping Huang
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Hong-Xiang Wang
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yi-Ran Huang
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ping Ping
- Department of Urology, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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Hong K, Zhao LM, Xu SX, Tang WH, Mao JM, Liu DF, Jiang H, Ma LL, Qiao J. Multiple factors affecting surgical outcomes and patency rates in use of single-armed two-suture microsurgical vasoepididymostomy: a single surgeon's experience with 81 patients. Asian J Androl 2016; 18:129-33. [PMID: 26289398 PMCID: PMC4736341 DOI: 10.4103/1008-682x.159718] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vasoepididymostomy (VE), as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong (KH). At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 (2-17) months. The patency rate was 66.1% (41/62). Natural pregnancy rate was 34.1% (14/41). Overall pregnancy rate was 22.6% (14/62). No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate: anastomosis sites (P = 0.035) and motile sperm found in the epididymal fluid (P = 0.006). Motile sperm found in the epididymal fluid were associated with a higher patency rate (OR = 11.80, 95% CI = 1.79, 77.65). The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.
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Affiliation(s)
| | | | | | | | | | | | - Hui Jiang
- Department of Urology, Peking University Third Hospital; Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
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14
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Abstract
A strong foundation in microsurgical techniques is imperative for urologists and clinical andrologists specializing in male infertility. Laboratory-based microsurgical training enhances surgical skills, improves surgeon confidence, and reduces stress and operating time, thereby benefiting both the patient and the surgeon. The laboratory environment additionally allows for the development of novel and innovative techniques. This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models.
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Affiliation(s)
- Akanksha Mehta
- 1 Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA 30322, USA ; 2 Department of Urology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| | - Philip S Li
- 1 Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA 30322, USA ; 2 Department of Urology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| | - Marc Goldstein
- 1 Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA 30322, USA ; 2 Department of Urology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
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15
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Zhao L, Tu XA, Zhuang JT, Chen Y, Wang WW, Zeng LY, Deng CH. Retrospective analysis of early outcomes after a single-armed suture technique for microsurgical intussusception vasoepididymostomy. Andrology 2015; 3:1150-3. [PMID: 26453438 DOI: 10.1111/andr.12111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/15/2015] [Accepted: 08/26/2015] [Indexed: 12/01/2022]
Affiliation(s)
- L. Zhao
- Department of Urology; Eastern Hospital of the First Affiliated Hospital; Guangzhou China
| | - X.-A. Tu
- Department of Urology; Eastern Hospital of the First Affiliated Hospital; Guangzhou China
| | - J.-T. Zhuang
- Department of Urology; Eastern Hospital of the First Affiliated Hospital; Guangzhou China
| | - Y. Chen
- Department of Urology; Eastern Hospital of the First Affiliated Hospital; Guangzhou China
| | - W.-W. Wang
- Department of Urology; Eastern Hospital of the First Affiliated Hospital; Guangzhou China
| | - L.-Y. Zeng
- Department of Urology; Eastern Hospital of the First Affiliated Hospital; Guangzhou China
| | - C.-H. Deng
- Department of Urology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
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16
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Vasoepididymostomy Anastomosis. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Two-suture single-armed longitudinal intussusception vasoepididymostomy for obstructive azoospermia: report of patients characteristics and outcome. Int Urol Nephrol 2014; 46:2271-7. [DOI: 10.1007/s11255-014-0835-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
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Abstract
Surgery for male infertility includes three main areas: varicocele surgery, recanalization of seminal tract, sperm retrieval.Varicocele treatment in infertily is still controversial. Recent scientific evidence appears to demonstrate that in selected cases varicocele treatment is beneficial in improving semen parameters and pregnancy rate. The key for the success of treatment seems to be a correct indication. It is our opinion that varicocele should be treated in presence of abnormal semen parameters, when clinically significant, and in adolescents with atrophy of the affected testis. So far, no specific technique, either surgical, microsurgical or sclerotherapic, can be considered the gold standard. Good results in our hands have been obtained with the microsurgical lymphatic sparing high ligation of internal spermatic vein.Innovations in surgery for seminal tract obstructions include the new tubular invagination techniques for epididimovasostomy, which showed excellent results with a simplified and time-saving microsurgical approach. In distal obstructions, a new transperineal ultrasound-guided approach has been proposed for the diagnostic work-up and treatment. Advantages of this technique and of the TURED must be balanced with those of immediate sperm retrieval for ART.In sperm retrieval, microTESE represents the most important surgical evolution in non-obstructive azoospermia. We have recently proposed a new stepwise approach starting with a minimal equatorial incision for conventional testicular biopsy which is extended to perform microTESE only when no sperm is retrieved. In this way microTESE is offered only to patients who really need it. Another field of innovation is sperm retrieval for ICSI in patients with Klinefelter Syndrome.
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19
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Kadioglu TC, Temple-Smith PD, Southwick G. Interpositional substitution of free vas deferens segment autografts in rat: feasibility and potential implications. BMC Urol 2014; 14:61. [PMID: 25103862 PMCID: PMC4148407 DOI: 10.1186/1471-2490-14-61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/30/2014] [Indexed: 12/05/2022] Open
Abstract
Background Insufficient vas length for performing a tension-free vasovasostomy is a problem occasionally encountered by microsurgeons. Herein we evaluated utilization of a non-vascularized vas deferens autograft in a rat model. Methods Segments of isolated vas deferens, 2.5 cm in length, were used as bilateral autografts in 15 rats. Each autograft was implanted between the two transected ends of vas deferens using end-to-end anastomosis. Fertility, sperm motility, and graft survival was evaluated and compared with the control group. Results At the end of the 3 months, 9/15 (60%) rats were able to breed successfully and 24 (80%) vas grafts were patent and viable. Large granulomata developed at the proximal anastomosis sites in 6 (20%) autografts that failed. Unilateral minimal fluid leakage was observed in 6 (20%) of the proximal (testicular end) anastomosis sites in those rats that were able to breed. Histological evaluations demonstrated that graft survival was associated with mild to severe changes in the structure of the vas autograft. On semen analysis 76% of the sperms in the experimental group had forward motility compared to 78% in the control group (p > 0.05). Conclusions Vas autograft can successfully be performed in a rat model with ultimate breeding capability.
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Affiliation(s)
- Teoman Cem Kadioglu
- Department of Urology, Istanbul School of Medicine, University of Istanbul, 34365 Istanbul, Turkey.
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21
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Abstract
Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility. Success in male infertility microsurgery is heavily dependent on the surgeon's microsurgical skills. Laboratory-based practice to enhance microsurgical skills improves the surgeon's confidence, and reduces stress and operating time, benefiting both the patient and the surgeon. This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models. The role of emerging techniques, such as robotic-assisted microsurgery, is also discussed.
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Affiliation(s)
- Akanksha Mehta
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
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22
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Abstract
Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy (VE). Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE (LIVE) in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the preoperative evaluation along with the techniques of various VE will be described in this article.
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Zhao L, Deng CH, Sun XZ, Chen Y, Wang WW, Zhao LY, Zeng LY, Tu XA. A modified single-armed technique for microsurgical vasoepididymostomy. Asian J Androl 2012; 15:79-82. [PMID: 23042447 DOI: 10.1038/aja.2012.100] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy (VE) in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm (>10(4) ml(-1)) in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men (58.8%), including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.
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Affiliation(s)
- Liang Zhao
- Department of Urology, Huangpu Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510700, China
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Fenig DM, Kattan MW, Mills JN, Gisbert M, Yu C, Lipshultz LI. Nomogram to preoperatively predict the probability of requiring epididymovasostomy during vasectomy reversal. J Urol 2011; 187:215-8. [PMID: 22099990 DOI: 10.1016/j.juro.2011.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE Up to 6% of men who undergo vasectomy may later undergo vasectomy reversal. Most men require vasovasostomy but a smaller subset requires epididymovasostomy. Outcomes of epididymovasostomy depend highly on specialized training in microsurgery and, if predicted preoperatively, might warrant referral to a specialist in this field. We created a nomogram based on preoperative patient characteristics to better predict the need for epididymovasostomy. MATERIALS AND METHODS We evaluated patients who underwent primary vasectomy reversal during a 5-year period. Preoperative and intraoperative patient data were collected in a prospectively maintained database. We evaluated the ability of age, years since vasectomy, vasectomy site, epididymal fullness and granuloma presence or absence to preoperatively predict the need for epididymovasostomy in a given patient. The step-down method was used to create a parsimonious model, on which a nomogram was created and assessed for predictive accuracy. RESULTS Included in the study were 271 patients with a mean age of 42 years. Patient age was not positively associated with epididymovasostomy. Mean time from vasectomy to reversal was 9.7 years. Time to reversal and a sperm granuloma were selected as important predictors of epididymovasostomy in the final parsimonious model. The nomogram achieved a bias corrected concordance index of 0.74 and it was well calibrated. CONCLUSIONS Epididymovasostomy can be preoperatively predicted based on years since vasectomy and a granuloma on physical examination. Urologists can use this nomogram to better inform patients of the potential need for epididymovasostomy and whether specialist referral is needed.
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Affiliation(s)
- David M Fenig
- Cheseapeake Urology Associates, Baltimore, Maryland 20759, USA
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Magheli A, Rais-Bahrami S, Kempkensteffen C, Weiske WH, Miller K, Hinz S. Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal. ACTA ACUST UNITED AC 2009; 33:730-5. [PMID: 19906186 DOI: 10.1111/j.1365-2605.2009.01007.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The objective of this study was to determine the effect of the obstructive interval and the presence of a sperm granuloma on vas patency and pregnancy rate following vasectomy reversal. We identified 334 patients with complete follow-up who met the inclusion criteria. There were significant associations between the obstructive interval and procedure performed as well as with patient age. Patients with longer obstructive intervals were more often older (p < 0.001) and more likely to have a vaseoepididymostomy performed (p < 0.001). There was no association between the presence of a sperm granuloma or the length of the obstructive interval with post-operative vas patency and pregnancy rates. The only independent predictor of post-operative fertility was age of the female partner (p = 0.015). Our data clearly demonstrates that when state of the art surgical techniques are used, neither the presence of a sperm granuloma nor the obstructive interval serve as prognosticators of post-operative vas patency and pregnancy rates. However, when counselling patients and their female partners, it is of utmost importance to stress that the age of the female partner is an independent predictor of successful vasectomy reversal.
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Affiliation(s)
- A Magheli
- Department of Urology, Charite-Universitatsmedizin Berlin, Campus Mitte, Berlin, Germany.
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