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Hibi H, Sugie M, Ohori T, Sonohara M, Fukunaga N, Asada Y. Microsurgical seminal reconstruction; our experiences in a single institute. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:477-485. [PMID: 33132432 PMCID: PMC7548240 DOI: 10.18999/nagjms.82.3.477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We assessed the contribution of microsurgical seminal reconstruction to achieving natural conception in conjunction with advanced assisted reproductive technologies. Ninety obstructive azoospermic subjects who underwent microsurgical seminal reconstruction were evaluated. Vasovasostomy (VV) was undertaken in 45 subjects whereas vasoepididymostomy (VE) in 45, respectively. VV was performed by employing a two microlayer anastomotic technique, whilst VE was undertaken using double needle longitudinal vaspepididymostomy (LIVE). Patency was achieved in 41 VV (91.1%), and 25 VE (55.6%) cases. In cases where patency was achieved, pregnancy and healthy delivery were recorded following natural intercourse in 7/41 (17.0%) VV, and in 7/25 (28.0%) VE cases. Where patency was not achieved, the use of cryopreserved sperm for intracytoplasmic sperm injection (ICSI), resulted in a healthy delivery in 4/4 (100%) VV and 14/21 (66.6%) in VE subjects. Although natural pregnancy was achieved only in a limited number of subjects treated (14/90; 15.6%), sperm harvested during surgery and cryopreserved for future ICSI use proved valuable, doubling the overall delivery rate (32/90; 36.6%). Surgical intervention is considered to be a useful technique in order to allow the possibility of a natural conception and by harvesting sperm at the same time contributes to the cost-effectiveness.
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Affiliation(s)
- Hatsuki Hibi
- Department of Urology, Kyoritsu General Hospital, Nagoya, Japan
| | - Miho Sugie
- Department of Urology, Kyoritsu General Hospital, Nagoya, Japan
| | - Tadashi Ohori
- Department of Urology, Kyoritsu General Hospital, Nagoya, Japan
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Tiwari DP, Razik A, Das CJ, Kumar R. Prospective analysis of factors predicting feasibility & success of longitudinal intussusception vasoepididymostomy in men with idiopathic obstructive azoospermia. Indian J Med Res 2019; 149:51-56. [PMID: 31115375 PMCID: PMC6507538 DOI: 10.4103/ijmr.ijmr_1192_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives : Microsurgical reconstruction for idiopathic obstructive azoospermia is a challenging procedure, and selection of appropriate patients is important for successful outcomes. This prospective study was done to evaluate the ability of scrotal ultrasound measurements to predict the surgical feasibility and determine factors that could predict a patent anastomosis following vaso-epididymal anastomosis (VE) in men with idiopathic obstructive azoospermia. Methods : In this prospective study, men diagnosed with idiopathic obstructive azoospermia, scheduled for a longitudinal intussusception VE, underwent a scrotal ultrasound measurement of testicular and epididymal dimensions. During surgery, site and type of anastomosis, presence of sperms in the epididymal fluid and technical satisfaction with the anastomosis were recorded. All men where VE could be performed were followed up for appearance of sperms in the ejaculate. Ultrasound parameters were compared between men who had a VE versus those with negative exploration. Predictive factors were compared between men with or without a patent anastomosis. Results : Thirty four patients were included in the study conducted between September 2014 and August 2016 and a VE was possible in only 19 (55%) patients. Of these 19 patients, six had a patent anastomosis with one pregnancy. Preoperative ultrasound measurements could not identify patients where a VE could not be performed. Motile sperm in the epididymal fluid was the only significant predictor of a successful anastomosis. Interpretation & conclusion : Forty five per cent of men planned for a VE for idiopathic obstructive azoospermia could not undergo a reconstruction. Ultrasound assessment of testicular and epididymal dimensions could not predict the feasibility of performing a VE. The presence of motile sperms in the epididymal fluid was the only significant predictor of a patent VE in our study.
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Affiliation(s)
- Devi Prasad Tiwari
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Abdul Razik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Yoon YE, Lee HH, Park SY, Moon HS, Kim DS, Song SH, Kim DK. The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta-analysis. Asian J Androl 2018; 21:238926. [PMID: 30106012 PMCID: PMC6337956 DOI: 10.4103/aja.aja_59_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/12/2018] [Indexed: 12/02/2022] Open
Abstract
This study comprises a systematic review and meta-analysis of microsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia. A comprehensive literature search was performed using Medline, Embase, and the Cochrane library that included all studies related to microsurgical vasoepididymostomy. Keywords included "vasoepididymostomy," "epididymovasostomy," "epididymal obstruction," and "epididymis obstruction." Event rate and risk ratio (RR) were estimated. Patency rate and pregnancy rate were investigated. The analysis comprised 1422 articles, including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017. The overall mean patency rate was 64.1% (95% confidence interval [CI]: 58.5%-69.3%; I2=83.0%), and the overall mean pregnancy rate was 31.1% (95% CI: 26.9%-35.7%; I2=73.0%). We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38% (95% CI: 1.21%-1.57%; P < 0.00001). A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR = 1.17%; 95% CI: 1.01%-1.35%; P = 0.04). Patients with motile sperm in epididymal fluid exhibited an RR of 1.53% (95% CI: 1.11%-2.13%; P = 0.01) with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.
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Affiliation(s)
- Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do 10444, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hong Sang Moon
- Department of Urology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Dong Suk Kim
- Department of Urology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
| | - Seung-Hun Song
- Department of Urology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Seoul Station Fertility Center, CHA University, Seoul 04637, Korea
- Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul 04763, Korea
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Harza M, Voinea S, Ismail G, Gagiu C, Baston C, Preda A, Manea I, Priporeanu T, Sinescu I. Predictive factors for natural pregnancy after microsurgical reconstruction in patients with primary epididymal obstructive azoospermia. Int J Endocrinol 2014; 2014:873527. [PMID: 24987417 PMCID: PMC4058594 DOI: 10.1155/2014/873527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 11/18/2022] Open
Abstract
Primary epididymal obstructive azoospermia (OA) is the most prevalent form of OA in nonvasectomized patients and has been less studied. We aim to assess the results with microsurgical vasoepididymostomy used in the treatment of men diagnosed with primary epididymal obstructive azoospermia and to identify the factors associated with natural pregnancy occurring after microsurgical reconstruction. This prospective study included consecutive patients with epididymal OA who underwent microsurgical reconstruction in our center. Clinical and biological data were obtained every three months during follow-up. Occurrence of natural pregnancy was the primary study outcome. In total, 36 patients underwent microsurgical reconstruction. The mean age was 34 ± 4.5 years (range 24-46 years). Median follow-up time was 15 [IQR 12-21] months. The total patency rate was 77.7% (n = 28). During follow-up, 8 (22.2%) natural pregnancies occurred. The overall live birth rate was 100%. Low FSH levels (HR: 0.22; 95% CI: 0.052-0.88; P = 0.032) and higher total motile sperm count (TMSC) (HR: 1.001; 95% CI 1-1.001; P = 0.012) were associated with a higher rate of natural pregnancy. Our data suggest that microsurgical vasoepididymostomy is an effective therapy of primary epididymal OA. Baseline lower FSH and higher TMSC were independent predictors for natural pregnancy occurrence.
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Affiliation(s)
- Mihai Harza
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Sebastian Voinea
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Gener Ismail
- Center of Internal Medicine-Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian Gagiu
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Catalin Baston
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Adrian Preda
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Ioan Manea
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Tiberiu Priporeanu
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
| | - Ioanel Sinescu
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, District 2, 022328 Bucharest, Romania
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Baker K, Sabanegh E. Obstructive azoospermia: reconstructive techniques and results. Clinics (Sao Paulo) 2013; 68 Suppl 1:61-73. [PMID: 23503955 PMCID: PMC3583161 DOI: 10.6061/clinics/2013(sup01)07] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 03/03/2012] [Indexed: 12/30/2022] Open
Abstract
Obstructive azoospermia is a common cause of male infertility and can result from infection, congenital anomalies, or iatrogenic injury. Microsurgical vasal reconstruction is a suitable treatment for many cases of obstructive azoospermia, although some couples will require sperm retrieval paired with in-vitro fertilization. The various causes of obstructive azoospermia and recommended treatments will be examined. Microsurgical vasovasostomy and vasoepididymostomy will be discussed in detail. The postoperative patency and pregnancy rates for surgical reconstruction of obstructive azoospermia and the impact of etiology, obstructive interval, sperm granuloma, age, and previous reconstruction on patency and pregnancy will be reviewed.
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Affiliation(s)
- Karen Baker
- Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Abstract
When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to have in mind when embarking on the evaluation. Adjunctive laboratory tests, such as hormonal assays or genetic studies, are often complementary and/or additive and allow a very precise determination to be made as to the etiologies, either genetic or acquired. It is only with this information that a therapeutic plan can be made for the patient. As will be discussed, a targeted approach to testing is far more satisfying and cost-effective than a blind, shotgun approach.
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Affiliation(s)
- Robert Oates
- Boston University School of Medicine, MA 02118, USA.
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