The effect of BMI and age on the outcomes of microsurgical vasoepididymostomy: a retrospective analysis of 181 patients operated by a single surgeon / 亚洲男科学杂志(英文版)

To design a treatment plan for patients with epididymal obstruction, we explored the potential impact of factors such as body mass index (BMI) and age on the surgical outcomes of vasoepididymostomy (VE). In this retrospective study, 181 patients diagnosed with obstructive azoospermia (OA) due to epididymal obstruction between September 2014 and September 2017 were reviewed. All patients underwent single-armed microsurgical intussusception VEs with longitudinal two-suture placement performed by a single surgeon (KH) in a single hospital (Peking University Third Hospital, Beijing, China). Six factors that could possibly influence the patency rates were analyzed, including BMI, age, mode of anastomosis, site of anastomosis, and sperm motility and quantity in the intraoperative epididymal fluid. Single-factor outcome analysis was performed via Chi-square test and multivariable analysis was performed using logistic regression. A total of 159 (87.8%, 159/181) patients were followed up. The follow-up time (mean ± standard deviation [s.d.]) was 27.7 ± 9.3 months, ranging from 12 months to 48 months. The overall patency rate was 73.0% (116/159). The multivariable analysis revealed that BMI and age significantly influenced the patency rate (P = 0.008 and 0.028, respectively). Younger age (≤28 years; odds ratio [OR] = 3.531, 95% confidence interval [95% CI]: 1.397-8.924) and lower BMI score (<26.0 kg m-2; OR = 2.352, 95% CI: 1.095-5.054) appeared to be associated with a higher patency rate. BMI and age were independent factors affecting the outcomes of microsurgical VEs depending on surgical expertise and the use of advanced technology.

Retrospective analysis of one-year outcomes after modified single-armed suture technique for microsurgical intussusception vasoepididymostomy / 中华显微外科杂志

Objective To retrospectively analyze the one-year outcomes of modified single-armed suture technique for microsurgical vasoepididymostomy in men with epididymal obstructive azoospermia (EOA).Methods From February,2012 to November,2013,microsurgical longitudinal intussusception vasoepididymostomies using a modified single-armed suture technique in 51 men with EOA was performed.The followed-up period was designed as 1 year.The correlations between the sperm motility in epididymal fluid,unilateral or bilateral procedure,anastomotic site,and the female partner age and the patency or pregnancy rate were analyzed.Results Followups were carried out for 39 (76.5％) men.The patency was noted in 24 (61.5％) men and pregnancy was reported in 15 (38.5％) female partners,including 1 received in vitro fertilization using fresh ejaculated sperm.Motile sperms in epididymal fluid were observed intraoperatively in 14 (58.3％) patent men and 3 (20.0％) nonpatent men,respectively (P ＜ 0.05).In patent cohort,the mean ages of the pregnant and non-pregnant female partners were 26.5 and 32.7 years(P ＜ 0.05),respectively.Conclusion The modified single-armed suture technique showed favourable patency and pregnancy rates in this study.It's a practical alternative in the areas without the specialized double armed suture.

Clinical Significance of No Appearance of Vasal Fluid on Testicular End of the Vas during Vasovasostomy / 대한비뇨기과학회지

The sperm count in semen analysis after vasovasostomy is significantly higher in men with vasal fluid in the proximal vas during the operation than in those without fluid on one or both sides(P<0.05). On 8(38.1%) of 21 sides in 12 men without vasal efflux during vasovasostomy secondary epididymal obstructions were found on scrotal exploration. Bilateral ductal obstructions were found in 3 of 9 men without vasal efflux on both sides. The cause of obstruction included spermatocele, chronic epididymal inflammation. In epididymal histology the cause of obstruction was the interstitial sperm granulomas resulting from the rupture of the epididymal duct and chronic epididymitis. We concluded that epididymal exploration is necessary in case with no sperm from testicular end of the vas on both sides.

Surgical Correction of Epididymal Obstruction / 대한비뇨기과학회지

During the period of 1964 to 1972, epididymovasoetomies were performed on 53 cases of azoospermias due to epididymal obstruction. They were operated by the technics of the ordinary side-to-side epididymovasostomy with splint, in such a manner that a minute longitudinal opening in the vas was anastomosed to a similar opening in the epididymis at a site where live sperm had been recovered, which was applied on 58 per cent of the subjects, and of the buried side-to-side anastomosis with a splint, wherein longitudinally opened vas ..was actually buried in longitudinally opened head of epididymis, which was attempted on 26 per cent of them. The following data are presented as abstraction of clinical findings and the operation outcomes: l. An average age of the subjects was 35, and that of their wives, 30. 2. An average duration intervening between the beginning of the obstruction and the performance of the operation was 9 years. 3. An average frequency of sexual intercourse per week indicated 2.5 times before the obstruction 2. 2 times after the obstruction, and 2. 1 times after the operation. 4. In the majority of the cases, the post-inflammatory obstructions were found to be the most responsible causes for azoospermia in my present study. That is, non-tuberculous epididymitis (gonorrheal and non-gonorrheal origin) was found in 70 per cent of the subjects and tuberculous origin, 25 per cent of them respectively. 5. Success rate of non-tuberculous epididymitis group is higher than that of tuberculous epididymitis counter part 6. Success rate of the buried technic group is higher than that of the ordinary technic group. 7. Success rate of bilateral oozes with sperm group is higher than that of unilateral oozes with sperm or no oozes group. 8. A total of 53 cases was operated upon for curing the obstructive azooepermias. Poet-operative semen analyses were carried out on 43 cases out of the 53. Sperm appeared in the ejaculates of 17 cases out of the 43 in repeated sperm tests 3 weeks following the operation. Accordingly, successful operations were showed in 40 per cent of the 43 cases. Seven pregnancies(16%) followed the operation. 9. The writer believes that epididymovasostomy could be said to be a worthwhile procedure for the cases of asooapermia due to the obstruction of globus minor with normal spermatogenesis. The prognosis is always good whenever the indications are strictly followed.