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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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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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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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Marinaro J, Goldstein M. Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes. J Clin Med 2022; 11:jcm11154593. [PMID: 35956208 PMCID: PMC9369943 DOI: 10.3390/jcm11154593] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
A male factor plays a significant role in a couple's reproductive success. Today, advances in reproductive technology, such as intracytoplasmic sperm injection (ICSI), have allowed it to be possible for just a single sperm to fertilize an egg, thus, overcoming many of the traditional barriers to male fertility, such as a low sperm count, impaired motility, and abnormal morphology. Given these advances in reproductive technology, it has been questioned whether a reproductive urologist is needed for the evaluation and treatment of infertile and subfertile men. In this review, we aim to provide compelling evidence that collaboration between reproductive endocrinologists and reproductive urologists is essential for optimizing a couple's fertility outcomes, as well as for improving the health of infertile men and providing cost-effective care.
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Affiliation(s)
- Jessica Marinaro
- Department of Urology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, 525 East 68th St., Starr Pavilion, 9th Floor (Starr 900), New York, NY 10065, USA
- Correspondence:
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Shamohammadi I, Sadighi Gilani MA, Kazemeyni SM, Hasanzadeh T, Taqi Dizaj AV, Dizavi A. Evaluation of Azoospermic Patients to Distinguish Obstructive from Non-Obstructive Azoospermia, and Necessity of Diagnostic Testis Biopsy: A Retrospective Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:156-161. [PMID: 36029050 PMCID: PMC9421263 DOI: 10.22074/ijfs.2021.532258.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Indexed: 12/01/2022]
Abstract
Accurate etiology of azoospermia is required for optimal management of patients. The aim of this<br />study was the determination of serum hormonal levels and testicular long axis cut off points to distinguish obstructive<br />azoospermia (OA) from non-OA (NOA) in Iranian patients as well as the evaluation of the necessity of diagnostic<br />testis biopsy in azoospermic patients.<br />Materials and Methods: In this retrospective study, data of 471 azoospermic patients such as history and physical<br />examination, serum hormonal level, semen fluid parameter, and testicular long axis based on ultrasound were<br />evaluated from 2016 to 2020. All patients were examined by a single urologist and underwent a diagnostic testis<br />biopsy for a definite diagnosis. The diagnostic parameters were analyzed using Statistical Package for the Social<br />Sciences (SPSS) version 16 with t test and chi-square test and receiver operating characteristic (ROC) curves to<br />distinguish NOA from OA.<br />Results: A total of 127 patients with OA and 284 with NOA were included in this study. The mean serum testosterone<br />level was significantly higher in OA than NOA (4.2 vs. 3.4 ng/ml), whereas the mean serum follicular stimulating hormone<br />(FSH, 5.3 vs. 19.1 mIU/ml) and luteinizing hormone (LH, 5.3 vs. 11 mIU/ml) were lower in OA. ROC curve analysis<br />showed that FSH and testicular long axis were the best diagnostic predictors. Using a combination of serum FSH (8.9<br />mIU/ml) and testicular long axis (39 mm), the positive predictive value for NOA was 97.02% and for OA was 78.8%.<br />Conclusion: Combination of serum FSH higher than 8.9 mIU/ml and testicular long axis lower than 39 mm were<br />strong predictors to distinguish NOA from OA in Iranian participants in this study. In addition, diagnostic testicular<br />biopsy seems to be necessary for patients with OA and NOA characteristics.
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Affiliation(s)
- Iman Shamohammadi
- Department of Urology, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran,Department of Urology, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Urology, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran,Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedi-
cine, ACECR, Tehran, Iran,P.O.Box: 1411713135Department of UrologyShariati HospitalTehran University of Medical ScienceTehranIran
| | | | - Tara Hasanzadeh
- Department of Urology, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Ahmad Vosough Taqi Dizaj
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedi-
cine, ACECR, Tehran, Iran
| | - Alireza Dizavi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedi-
cine, ACECR, Tehran, Iran
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Paul CJ, West JM, Wald M. Association between the lengths of excised obstructed vas deferens segments at the time of vasovasostomy and surgical outcomes. Turk J Urol 2020; 47:3-8. [PMID: 33085604 DOI: 10.5152/tud.2020.20266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine whether the length of the excised obstructed vas deferens at vasovasostomy (VV) performed for fertility is associated with semen parameters and/or pregnancy outcomes postoperatively. MATERIAL AND METHODS The patients who underwent a VV at our institution from September 2004 to December 2018 were contacted via questionnaire and a chart review was performed. Linear and logistic regression models were used to determine the associations between the length of the obstructed vas deferens removed and postoperative outcomes including sperm concentration, motility, and successful pregnancy after reversal. RESULTS A total of 83/170 questionnaires were returned. After exclusions, a total of 35 patients were included for analysis. The mean age of the patients at the time of surgery was 40.1 years and the mean time since vasectomy 9.3 years. The mean length of the obstructed vas deferens removed during VV was 2.25 cm. The longer the vas deferens segments removed, the more significant was the increase in sperm motility at 3 and 9 months postoperatively (p=0.011 and 0.008, respectively), but decreased sperm motility at 6 months (p=0.029). In 75.9% of the patients, sperm was present postoperatively, 23.2% achieved pregnancy through natural conception, and 55.8% achieved pregnancy using assisted reproductive techniques. There was no significant relationship between the length of the vas deferens removed and sperm concentration or pregnancy achieved after surgery. CONCLUSION In this cohort, the length of the excised obstructed vas deferens at VV was associated with improved sperm motility at 3 and 9 months postoperatively but not with pregnancy outcomes.
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Affiliation(s)
- Charles J Paul
- Department of Urology, University of Iowa, Iowa City, Iowa, United States
| | - Jeremy M West
- Department of Urology, University of Iowa, Iowa City, Iowa, United States
| | - Moshe Wald
- Department of Urology, University of Iowa, Iowa City, Iowa, United States
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