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Wang SY, Fang YY. Outcomes of microsurgical vasoepididymostomy using intussusception technique: a systematic review and meta‑analysis. Sci Rep 2023; 13:3340. [PMID: 36849574 PMCID: PMC9971252 DOI: 10.1038/s41598-023-28637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023] Open
Abstract
A systematic review and meta-analysis of microsurgical vasoepididymostomy (MVE) for treating epididymal obstructive azoospermia (EOA) with different intussusception techniques. We conducted a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, retained literature related to obstructive azoospermia or male infertility and vasoepididymostomy, proactively reviewed other relevant literature, supplemented valuable references, and excluded studies that did not use intussusception and where valuable statistical data were difficult to obtain. Event rate and risk ratio (RR) were estimated. Patency rates were investigated. The influence of motile sperms found in the epididymal fluid, anastomotic sides and sites on patency was evaluated. 273 articles were comprised in this analysis, and 25 observational studies were eventually included, with a total patient sample of 1400. The overall mean patency rate was 69.3% (95% confidence interval [CI] 64.6-73.6%; I2 = 63.735%). We conducted a meta-analysis of the factors affecting patency after microsurgical IVE, finding that the presence of motile sperms in epididymal fluid (RR = 1.52; 95% CI 1.18-1.97%; P = 0.001), anastomosing bilaterally (RR = 1.32; 95% CI 1.15-1.50%; P < 0.0001) and distally (RR = 1.42; 95% CI 1.09-1.85%; P = 0.009) lead to higher patency rates. IVE is an effective treatment for EOA. The presence of motile sperms found in the epididymal fluid, anastomosing bilaterally and distally are significantly correlated with higher patency rates.
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Affiliation(s)
- Shou-yang Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Yang-yi Fang
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, 100191 China
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2
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The Diversity of Vasectomy Reversal Providers and Their Web-based Advertising Habits in the United States. Urology 2023; 174:104-110. [PMID: 36750135 DOI: 10.1016/j.urology.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To better understand the internet advertising material published on clinician websites for the 30,000 men who undergo evaluation for vasectomy reversal (VR), which is a technically demanding procedure requiring microsurgical expertise. METHODS Internet search trends for "vasectomy" and "vasectomy reversal" from 2004 to 2022 were assessed using Google Trends. Search engines were then queried on a state-by-state basis for physicians performing VR and the available information aggregated and analyzed using standard statistical approaches. RESULTS VR search volume consistently represented roughly one-tenth of the search volume for vasectomy. One hundred and ninety reversal clinics were identified in 44 of 50 states with the highest number identified in the southeast region and an overall median price of $6500. Ninety percent of physicians were male and completed residencies in urology. Other specialties included obstetrics and gynecology, general surgery, family medicine and orthopedic surgery. Forty-two percent of urologists had completed infertility fellowships. Sixty percent of physicians utilized a microscope, and 4.7% of physicians explicitly stated they did not perform vasoepididymostomy even when indicated. Fifty two percent of clinics reported VR success rates as high as 100%, and 34% of clinics reported pregnancy outcomes. Twenty-five percent of clinics reported out-of-pocket VR pricing and 26% discussed possible complications. CONCLUSION VR is a technically demanding cash-pay procedure being performed by physicians with a wide array of backgrounds and outcomes. Urologists should strive to lead by example and report their training, personal experiences, and expected outcomes to enable optimal medical decision making for each patient.
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Basourakos SP, Lewicki P, Punjani N, Arenas-Gallo C, Gaffney C, Fantus RJ, Al Awamlh BAH, Schlegel PN, Brannigan RE, Shoag JE, Halpern JA. Practice patterns of vasal reconstruction in a large United States cohort. Andrologia 2021; 53:e14228. [PMID: 34459018 DOI: 10.1111/and.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
We aimed to characterise diverse practice patterns for vasal reconstruction and to determine whether surgeon volume is associated with vasoepididymostomy performance at the time of reconstruction. We identified adult men who underwent vasal reconstruction from 2000 to 2020 in Premier Healthcare Database and determined patient, surgeon, cost and hospital characteristics for each procedure. We identified 3,494 men who underwent either vasovasostomy-alone (N = 2,595, 74.3%) or any-vasoepididymostomy (N = 899, 25.7%). The majority of providers (N = 487, 88.1%) performed only-vasovasostomy, 10 (1.8%) providers performed only-vasoepididymostomy and 56 (10.1%) providers performed both. Median total hospital charge of vasoepididymostomy was significantly higher than vasovasostomy ($39,163, interquartile range [IQR]$11,854-53,614 and $17,201, IQR$10,904-29,986, respectively). On multivariable regression, men who underwent procedures at nonacademic centres (OR 2.71, 95% CI 2.12-3.49) with higher volume surgeons (OR 11.60, 95% CI 8.65-16.00) were more likely to undergo vasoepididymostomy. Furthermore, men who underwent vasoepididymostomy were more likely to self-pay (OR 2.35, 95% CI 1.83-3.04, p < .001) and more likely had procedures in the Midwest or West region (OR 2.22, 95% CI 1.66-2.96 and OR 2.11, 95% CI 1.61-2.76, respectively; p < .001). High-volume providers have increased odds of performing vasoepididymostomy at the time of reconstruction but at a significantly higher cost. These data suggest possibly centralising reconstructive procedures among high-volume providers.
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Affiliation(s)
- Spyridon P Basourakos
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Patrick Lewicki
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Nahid Punjani
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher Gaffney
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Peter N Schlegel
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan E Shoag
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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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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Fantus RJ, Halpern JA. Vasovasostomy and vasoepididymostomy: indications, operative technique, and outcomes. Fertil Steril 2021; 115:1384-1392. [PMID: 33926720 DOI: 10.1016/j.fertnstert.2021.03.054] [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: 02/15/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022]
Abstract
The basic principles of vasal reconstruction have endured since their initial description over a century ago, yet the nuances and technical approaches have evolved. Prior to performing vasectomy reversal, the clinician should perform a focused history, physical and laboratory assessment, all of which are critical for patient counseling and preoperative planning. Operative success is contingent on appropriate intraoperative decision making and technical precision in completing a tension-free, watertight, and patent anastomosis. Outcomes of vasectomy reversal differ on the basis of the type of reconstruction required, reconstructive technique, and patient-specific factors. Here we review the indications, surgical techniques, and outcomes of vasectomy reversal.
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Affiliation(s)
- Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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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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7
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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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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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Pathak US, Balasubramanian A, Beilan JA, Butaney M, Tatem AJ, Thirumavalavan N, Lipshultz LI. Vasoepididymostomy: an insight into current practice patterns. Transl Androl Urol 2019; 8:728-735. [PMID: 32038969 DOI: 10.21037/tau.2019.11.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Vasectomy reversal (VR) is a specialized procedure currently offered by an increasing number of medical practitioners. One method of VR, vasoepididymostomy (VE), is considered the most challenging microsurgical technique within the field of reproductive urology. We surveyed reproductive urologists to assess current practice patterns regarding both intra-operative and post-operative considerations surrounding VE, with the hypothesis being that more experienced surgeons may have different practice patterns than less experienced surgeons. Methods An anonymous questionnaire was sent to members of the Society for Male Reproduction and Urology (SMRU). The survey included questions regarding case volume, preferred intra-operative techniques, and post-operative management strategies. Responses were collected using Survey Monkey (San Mateo, CA) and statistically analyzed with chi square tests. Results Three hundred and twenty SMRU members were contacted to participate in the survey; 74/320 (23.1%) participants completed the survey in its entirety. Respondents performed varying amounts of VR annually with most surgeons (24%) reporting between 11-20 VR per year and 15 surgeons (20.3%) performed over 60 per year. Comparing practitioners who performed ≤30 VR's annually (n=46) to providers who performed >30 (n=28) revealed a significantly lower rate of VE in low-volume practitioners (≤20% vs. >20%, P<0.0001). The most commonly used technique to create the epididymotomy involved placing two 10-0 sutures into the tubule, followed by a sharp incision between the needles (74.3% of respondents). An intussusception anastomosis was the most commonly reported technique; 46.0% of participants utilize longitudinal stitch placement, while 35.1% place sutures horizontally. The most commonly reported time interval to evaluate the first post-reversal semen analysis (SA) was 6-8 weeks (39.2%). Participants were also asked to rank the progression of adjunctive therapies employed in the setting of a subpar post-reversal SA. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most popular first-line management option (52.7%). Corticosteroids were the most frequently employed second-line option (37.8%). Referral to an in vitro fertilization (IVF) center (9.5%) and repeat surgery (2.7%) were also options pursued by survey respondents. Most providers repeated the SA every 8-12 weeks (41.2%) while following sub-par SA parameters. Conclusions VE is a technically demanding procedure that requires both microsurgical expertise and appropriate post-operative care. Our analysis demonstrates that a higher VR operative volume is associated with a higher rate of conversion to VE. This indicates either more experienced surgeons are more likely to perform a VE when indicated or more experience surgeons are getting referred and/or performing more complex VRs.
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Affiliation(s)
| | | | - Jonathan A Beilan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mohit Butaney
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Alexander J Tatem
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nannan Thirumavalavan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.,Urology Institute, University Hospitals/Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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10
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Vieiralves RR. Editorial Comment: Portable model for vasectomy reversal training. Int Braz J Urol 2019; 45:1020-1021. [PMID: 31626523 PMCID: PMC6844340 DOI: 10.1590/s1677-5538.ibju.2019.0092.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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11
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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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12
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Liang ZY, Zhang FB, Li LJ, Li JP, Wu JG, Chen C, Zhu YM. Clinical application of cross microsurgical vasovasostomy in scrotum for atypical obstructive azoospermia. J Zhejiang Univ Sci B 2019; 20:282-286. [PMID: 30829015 DOI: 10.1631/jzus.b1800303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Seminal duct obstruction may result in obstructive azoospermia (OA) and severe oligoasthenoteratozoospermia (OAT) (<0.5 million/mL) (Nordhoff et al., 2015). Cases of partial OA and OAT can be treated effectively by microsurgical anastomosis (Goldstein and Kim, 2013) to obtain successful surgical reversal. However, microsurgical vasovasostomy (VV) (Dickey et al., 2015) and vasoepididymostomy (VE) (Peng et al., 2017) are not suitable for patients with atypical OA and poor epididymis conditions or unpredictable obstruction of the distal vas deferens. For those patients, cross anastomosis may be applied instead of routine VE or VV. A single-center, retrospective, comparison study was conducted, which assessed the usefulness of the cross VV (CVV) in the scrotum for indication and efficacy. A total of 77 cases with OA or OAT were included, and 20 cases implemented cross anastomosis, including unilateral CVV (UCVV) in 4 cases, unilateral VE plus CVV (UVE+CVV) in 11 cases, and unilateral VV-based CVV (UVV+CVV) in 5 cases. The other 57 cases received no cross-matching anastomosis. The patency and natural pregnancy rates in one year were 75.0% and 50.0%, respectively, in the UCVV group; 54.5% and 27.3%, respectively, in the UVE+CVV group; and 60.0% and 40.0%, respectively, in the UVV+CVV group. The CVV in the scrotum in the selected patients with OA and severe OAT could yield good results. We regard the CVV in the scrotum as an efficacious operation with a lower risk of injury in cases of atypical OA.
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Affiliation(s)
- Zhong-Yan Liang
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Feng-Bin Zhang
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Le-Jun Li
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jing-Ping Li
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jing-Gen Wu
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Chong Chen
- Department of Ultrasonography, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yi-Min Zhu
- Department of Reproductive Endocrinology, Reproductive Medicine Center, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, 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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14
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Namekawa T, Imamoto T, Kato M, Komiya A, Ichikawa T. Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade. Reprod Med Biol 2018; 17:343-355. [PMID: 30377390 PMCID: PMC6194271 DOI: 10.1002/rmb2.12207] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception. METHODS This article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches. MAIN FINDINGS The reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot-assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery. CONCLUSION In the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.
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Affiliation(s)
- Takeshi Namekawa
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Takashi Imamoto
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Mayuko Kato
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Akira Komiya
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Tomohiko Ichikawa
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
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15
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Naz M, Kamal M. Classification, causes, diagnosis and treatment of male infertility: a review. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s13596-017-0269-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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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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Zhang Y, Wu X, Yang XJ, Zhang H, Zhang B. Vasal vessels preserving microsurgical vasoepididymostomy in cases of previous varicocelectomy: a case report and literature review. Asian J Androl 2016; 18:154-6. [PMID: 26608943 PMCID: PMC4736349 DOI: 10.4103/1008-682x.166432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yan Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
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Li B, Chen G, Wang X. Treatment of failed vasectomy reversal using a microsurgical two-layer anastomosis technique. Transl Androl Urol 2016; 2:94-8. [PMID: 26816731 PMCID: PMC4708221 DOI: 10.3978/j.issn.2223-4683.2013.06.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the application of a microsurgical two-layer anastomosis technique in the treatment of failed vasectomy reversal. METHODS A microsurgical two-layer anastomosis was used in a series of 24 patients with confirmed anastomotic obstruction after previous vasectomy reversal. The patients were followed up for 9 months to 6 years, and the efficacy of the procedure was evaluated by regular seminal analysis and pregnancy records. The results were compared with those obtained from 34 patients who had received primary microsurgical vasovasostomy in our hospital using the same microsurgical technique. RESULTS In the treatment group for failed vasectomy reversal patients, the postoperative patency rate was 87.5% (21/24), resulting in a pregnancy rate of 54.2% (13/24). In primary reversal group, the postoperative patency rate was 94.1% (32/34), resulting in a pregnancy rate of 67.6% (23/34). Both the patency and pregnancy rate were not significantly different between these two groups. CONCLUSIONS The microsurgical vasovasostomy and vasoepididymostomy provided satisfactory patency rate and natural pregnancy rate for patients with a previous failed vasectomy reversal, which is comparable with the results of patients who had undergone primary procedure.
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Affiliation(s)
- Bingkun Li
- 1 Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China ; 2 Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Guoling Chen
- 1 Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China ; 2 Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiang Wang
- 1 Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China ; 2 Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
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Jiang HT, Yuan Q, Liu Y, Liu ZQ, Zhou ZY, Xiao KF, Yang JG. Multiple advanced surgical techniques to treat acquired seminal duct obstruction. Asian J Androl 2015; 16:912-6. [PMID: 25337841 PMCID: PMC4236339 DOI: 10.4103/1008-682x.139256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the outcomes of multiple advanced surgical treatments (i.e. microsurgery, laparoscopic surgery and endoscopic surgery) for acquired obstructive azoospermia. We analyzed the surgical outcomes of 51 patients with suspected acquired obstructive azoospermia consecutively who enrolled at our center between January 2009 and May 2013. Modified vasoepididymostomy, laparoscopically assisted vasovasostomy and transurethral incision of the ejaculatory duct with holmium laser were chosen and performed based on the different obstruction sites. The mean postoperative follow-up time was 22 months (range: 9 months to 52 months). Semen analyses were initiated at four postoperative weeks, followed by trimonthly (months 3, 6, 9 and 12) semen analyses, until no sperm was found at 12 months or until pregnancy was achieved. Patency was defined as >10,000 sperm ml−1 of semen. The obstruction sites, postoperative patency and natural pregnancy rate were recorded. Of 51 patients, 47 underwent bilateral or unilateral surgical reconstruction; the other four patients were unable to be treated with surgical reconstruction because of pelvic vas or intratesticular tubules obstruction. The reconstruction rate was 92.2% (47/51), and the patency rate and natural pregnancy rate were 89.4% (42/47) and 38.1% (16/42), respectively. No severe complications were observed. Using multiple advanced surgical techniques, more extensive range of seminal duct obstruction was accessible and correctable; thus, a favorable patency and pregnancy rate can be achieved.
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Affiliation(s)
| | | | - Yu Liu
- Department of Urology, Shenzhen People's Hospital, Shenzhen 518020, China
| | | | | | | | - Jiang-Gen Yang
- Department of Urology, Shenzhen People's Hospital, Shenzhen 518020, China
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Dickey RM, Pastuszak AW, Hakky TS, Chandrashekar A, Ramasamy R, Lipshultz LI. The Evolution of Vasectomy Reversal. Curr Urol Rep 2015; 16:40. [DOI: 10.1007/s11934-015-0511-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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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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Dalela D, Ahlawat R, Sood A, Jeong W, Bhandari M, Menon M. The growth of computer-assisted (robotic) surgery in urology 2000-2014: The role of Asian surgeons. Asian J Urol 2015; 2:1-10. [PMID: 29264114 PMCID: PMC5730690 DOI: 10.1016/j.ajur.2014.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/28/2014] [Accepted: 09/06/2014] [Indexed: 11/25/2022] Open
Abstract
Objective A major role in the establishment of computer-assisted robotic surgery (CARS) can be traced to the work of Mani Menon at Vattikuti Urology Institute (VUI), and of many surgeons of Asian origin. The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines, improving patient comfort and disease outcomes and helping the industrial growth. The present paper gives an overview of the progress and development of robotic surgery, especially in the field of Urology; and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world. Methods PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014, using algorithms based on keywords “robotic surgery”, ”prostate”, “kidney”, “adrenal”, “bladder”, “reconstruction”, and “kidney transplant”. Inclusion criteria used were published full articles, book chapters, clinical trials, prospective and retrospective series, and systematic reviews/meta-analyses written in English language. Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion, and focused on techniques of robotic surgery, relevant patient outcomes and associated demographic trends. Results A total of 58 articles selected for final review highlight the important strides made by robots in urology, from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014. In the hands of an experienced robotic surgeon, it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery, especially in urologic oncology and reconstructive urology. With increasing surgeon proficiency, the benefits of robotic surgery were consistently seen across different surgical disciplines, patient populations, and strata. Conclusion The addition of robot to the surgical armamentarium has allowed better patient care and improved disease outcomes. VUI and surgeons of Asian origin have played a pioneering role in dissemination of computer-assisted surgery.
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Affiliation(s)
- Deepansh Dalela
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Rajesh Ahlawat
- Medanta Hospitals - Medanta Vattikuti Urology Institute, Gurgaon, Haryana, India
| | - Akshay Sood
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Wooju Jeong
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Mahendra Bhandari
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Mani Menon
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
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Dalela D, Ahlawat R, Sood A, Jeong W, Bhandari M, Menon M. WITHDRAWN: The growth of computer-assisted (robotic) surgery in urology 2000–2014: The role of Asian surgeons. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Taniguchi H, Iwamoto T, Ichikawa T, Nagai A, Okada H, Fujisawa M, Tsujimura A, Shiraishi K, Hibi H, Nagao K, Iwasaki A, Kamba T, Tomomasa H, Takada S, Matsuda T. Contemporary outcomes of seminal tract re-anastomoses for obstructive azoospermia: a nationwide Japanese survey. Int J Urol 2014; 22:213-8. [PMID: 25252153 DOI: 10.1111/iju.12631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/27/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate current outcomes of seminal tract re-anastomoses in Japan, and to compare them with historical data. METHODS A total of 213 patients with obstructive azoospermia who underwent seminal tract re-anastomosis from April 2008 to March 2012 at 25 institutions were enrolled in the present study. The outcomes of the procedure were compared with those reported in a previous multi-institutional study carried out in 2000. RESULTS The percentage of partners aged over 35 years was 37%. A microsurgical double-layer anastomosis was carried out 83.0% of the time. Sperm were observed in ejaculate postoperatively in 68.9% and 41.5% of patients who underwent a vasovasostomy or a vasoepididymostomy, respectively. Natural conception occurred in 27.5% of patients after a vasectomy and 32.3% of patients with an epididymal obstruction. Except for the ratio of natural conception in patients with vasal obstruction after herniorrhaphies, there were no significant differences in final ratios of sperm appearance and natural conception between the previously reported study and the present study. CONCLUSIONS Compared with historical data, contemporary seminal tract re-anastomosis in Japan seems to provide equivalent or better outcomes, depending on the cause of obstruction. Seminal tract re-anastomosis is a valid treatment option for patients with obstructive azoospermia.
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Affiliation(s)
- Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Robotic microsurgery in male infertility and urology-taking robotics to the next level. Transl Androl Urol 2014; 3:102-12. [PMID: 26816758 PMCID: PMC4708299 DOI: 10.3978/j.issn.2223-4683.2014.01.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/24/2014] [Indexed: 12/21/2022] Open
Abstract
The initial reports of robotic assisted microsurgery began to appear in the early 1990s. Animal and early human studies were the initial publications. Larger series papers have recently been published from a few institutions. The field of robotic assisted microsurgery is still in evolution and so are adjunctive tools and instruments. It is clearly a different and unique skill set-is it microsurgery or is it robotic surgery, or both. It is clear from history that the art of surgery evolves over time to encompass new technology as long as the outcomes are better for the patient. Our current robotic platforms may not be ideal for microsurgery, however, the use of adjunctive tools and instrument refinement will further its future potential. This review article presents the current state of the art in various robotic assisted microsurgical procedures in male infertility and urology. Some novel applications of taking microsurgery to areas not classically accessible (intra-abdominal vasovasostomy) and adjunctive tools will also be presented.
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Lue TF, Goldstein M. Surgeries in andrology: optimization and patients' well being. Asian J Androl 2013; 15:3-4. [PMID: 23241635 PMCID: PMC3739124 DOI: 10.1038/aja.2012.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tom F Lue
- Professor and Vice Chair, Emil Tanagho Endowed Chair in Clinical Urology, Department of Urology University of California, San Francisco, CA 94143-0738, USA (E-mail: )
- Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology, Weill-Cornell Medical College of Cornell University, Surgeon-in-Chief, Male Reproductive Medicine and Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY 10065, USA (E-mail: )
| | - Marc Goldstein
- Professor and Vice Chair, Emil Tanagho Endowed Chair in Clinical Urology, Department of Urology University of California, San Francisco, CA 94143-0738, USA (E-mail: )
- Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology, Weill-Cornell Medical College of Cornell University, Surgeon-in-Chief, Male Reproductive Medicine and Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY 10065, USA (E-mail: )
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