Clinical application of cross microsurgical vasovasostomy in scrotum for atypical obstructive azoospermia / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

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.

The role of varicocele treatment in the management of non-obstructive azoospermia

The literature on male reproductive medicine is continually expanding, especially regarding the diagnosis and treatment of infertility due to non-obstructive azoospermia. The advent of in vitro fertilization with intracytoplasmic sperm injection has dramatically improved the treatment of male infertility due to nonobstructive azoospermia. Assisted reproduction using testicular spermatozoa has become a treatment of hope for men previously thought to be incapable of fathering a child due to testicular failure. In addition, numerous studies on non-obstructive azoospermia have reported that varicocelectomy not only can induce spermatogenesis but can also increase the sperm retrieval rate; however, the value of varicocelectomy in patients with non-obstructive azoospermia still remains controversial. The purpose of this review is to present an overview of the current status of varicocele repair in men with non-obstructive azoospermia.

Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology

OBJECTIVE: Analyze whether testicular histologic patterns from a group of azoospermic men with varicocele is predictive of treatment outcome after subinguinal microsurgical varicocele repair. MATERIALS AND METHODS: Seventeen azoospermic men underwent bilateral open single testis biopsy and microsurgical subinguinal repair of clinical varicoceles. RESULTS: Histopathology of testicular biopsies revealed hypospermatogenesis (HYPO) in 6 men, maturation arrest (MA) in 5, and Sertoli cell-only (SCO) in 6. Overall, presence of spermatozoa in the ejaculates was achieved in 47 percent (8/17) of men after varicocele repair, but only 35 percent (6/17) of them had motile sperm in their ejaculates. Only men with testicular histology revealing HYPO (5/6) or maturation arrest (3/5) had improvement after surgery. Median (25 percent - 75 percent percentile) postoperative motile sperm count for both groups were 0.9 X 106/mL (0.1-1.8 X 106/mL) and 0.7 X 106/mL (0.1-1.1), respectively (p = 0.87). The mean time for appearance of spermatozoa in the ejaculates was 5 months (3 to 9 months). One (HYPO) of 8 (12.5 percent) men who improved after surgery contributed to an unassisted pregnancy. Postoperative testicular biopsies obtained from patients who had no improvement after surgery revealed that testicular histology diagnosis remained unchanged. Successful testicular sperm retrieval for intracytoplasmic sperm injection (ICSI) was achieved in 4 of 9 (44.4 percent) individuals who did not improve after surgery, including 1 man with testicular histology exhibiting SCO. CONCLUSION: Microsurgical varicocele repair in nonobstructive azoospermic men with clinical varicoceles can result in sperm appearance in the ejaculate when hypospermatogenesis or maturation arrest is found on testicular histology diagnosis.

Bilateral varicocelectomy versus unilateral in management of oligoatheno - spermia

In this prospective study, the effects of unilateral operative interference on the affected side with bilateral surgery and the other clinically appearing free side were compared. The diagnoses were achieved clinically and confirmed by Doppler US, which was also used to detect a subclinical varicocele and to assess the degree of venous reflux. This comparative prospective study was based upon the results of pre and postoperative seminal analysis and Doppler studies US of venous drainage of both testes. The study included two groups of infertile males: Group I included 30 cases underwent unilateral surgery and group II included 30 cases underwent bilateral surgery. Three months postoperatively, seminal analysis of the studied cases showed an improvement in the number and initial motility as well as a decrease in the number of abnormal forms in 60% of group I and 90% in group II. Also, the study showed that there was a relation between the degree of reflux and the improvement in the seminal parameter

Vasectomía en unidades de medicina familiar: análisis del seguimiento a pacientes / Vasectomy in family medicine units: analysis of patient follow-up

Introducción: el proceso de atención de la vasectomía sin bisturí, además de la consejería y la cirugía, incluye el seguimiento para corroborar la azoospermia; sin embargo más de 50 por ciento de pacientes no lo concluye.Objetivo: evaluar el seguimiento posvasectomía y los criterios del personal médico.Material y métodos: en un estudio observacional se entrevistaron pacientes vasectomizados y médicos de 36 clínicas del Instituto Mexicano del Seguro Social. De los vasectomizados se registró información sobre el seguimiento, aparición de complicaciones, cumplimiento de las citas para revisión posquirúrgica, espermatobioscopia y revisión de resultados. De los médicos se registraron criterios de revisión posquirúrgica para solicitar espermatobioscopia y de evaluación de resultados (alta o fracaso.)Resultados: se entrevistaron 2063 pacientes; 94 por ciento había recibido información, sin embargo, sólo 3.5 por ciento completó el seguimiento. Los pacientes no finalizaron el seguimiento por falta de tiempo, olvido, incompatibilidad con el horario de trabajo y desinformación. También se entrevistaron 62 médicos, la mayoría de los cuales conocía las normas. Su criterio para solicitar espermatobioscopia fue practicarla cumplidas 20 o más eyaculaciones posvasectomía. En caso de espermatobioscopia positiva, solicitaron nuevo examen. Consideraron fracaso una segunda espermatobioscopia positiva. Su criterio de alta fue la azoospermia.Conclusiones: la falta de información y motivación en los pacientes y las barreras organizacionales impiden un seguimiento apropiado. El criterio médico coincide con los establecidos institucionalmente

Tratamento cirúrgico da azoospermia obstrutiva / Surgical treatment of obstructive azoospermia

Duzentos e dezessete pacientes portadores de azoospermia foram estudados. Vinte e três indivíduos com agenesia bilateral do deferente, 20 com azoospermia pós-vasectomia e 23 com obstruçäo ao nível do epidídimo, constituem o motivo desta apresentaçäo. Em três pacientes com agenesia bilateral do deferente, realizou-se espermatocele artificial; nos vasectomizados procedeu-se à vaso-vasostomia microcirúrgica em dois planos e no 3ª grupo à anastomose epidídimo-deferencial término-terminal. Nos casos de espermatocele, um demonstrou a presença de espermatozóides no pós-operatório, porém näo houve gravidez, e os demais continuaram azoospérmicos. Com a vaso-vasostomia obteve-se 100% de permeabilidade canalicular e 72,7% de gravidez. Nos pacientes submetidos à vaso-epidídimo-anastomose verificou-se 50% de permeabilidade e 25% de gravidez

Reconstruçäo microcirúrgica do canal deferente: experiência com 47 casos / Microsurgical reconstruction of the vas deferens: experience with 47 cases

Os índices de sucesso na reconstruçäo do trato seminal eram bastante modestos quando se empregavam as técnicas de cirurgia convencional e melhoraram de forma significativa com a introduçäo em clínica dos procedimentos microcirúrgicos. Foram analisados os aspectos clínicos e os resultados do tratamento de 47 casos de azoospermia obstrutiva submetidos à reconstruçäo microcirúrgica do trato seminal. Após período de seguimento que variou entre 1 e 79 meses, reaparecimento de espermatozóides no esperma ocorreu em 27 de 30 pacientes (90%) submetidos à vasoanastomose e em 2 de 7 pacientes (27%) submetidos à vasoepididimoanastomose ipsilateral. Nesse mesmo período, os índices de gravidez foram respectivamente de 63% e de 14%. A ausência de complicaçöes cirúrgicas e os índices satisfatórios de repermeabilizaçäo da via seminal observados, justificam o emprego da microcirurgia como método preferencial de tratamento dos quadros de azoospermia obstrutiva

Tratamento cirúrgico da azoospermia obstrutiva / Surgical treatment of obstructive azoospermia

Duzentos e dezessete pacientes portadores de azoospermia foram estudados. Vinte e três indivíduos apresentaram agenesia bilateral do deferente, vinte pacientes com azoospermia pós-vasectomia e vinte e três pacientes com obstruçäo ao nível do epidídimo constituem o motivo desta apresentaçäo. Em três pacientes com agenesia bilateral do deferente, realizou-se espermatocele artificial; nos vasectomizados procedeu-se à vaso-vasostomia microcirúrgica em dois planos e no 3§ grupo à anastomose epidídimo-deferencial término-terminal. Nos casos de espermatocele, um demonstrou a presença de espermatozóides no pós-operatório, porém näo houve gravidez, e os demais continuaram azoospérmicos. Com a vaso-vasostomia obteve-se 100% de permeabilidade canalicular e 54,5% de gravidez. Nos pacientes submetidos à vaso-epidídimo anastomose verificou-se 50% de permeabilidade e 16,6% de gravidez