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.

Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia: a tertiary care center experience / 亚洲男科学杂志(英文版)

Patients with congenital unilateral absence of the vas deferens (CUAVD) manifest diverse symptoms from normospermia to azoospermia. Treatment for CUAVD patients with obstructive azoospermia (OA) is complicated, and there is a lack of relevant reports. In this study, we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA. From December 2015 to December 2020, 33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital (Shanghai, China). Patient information, ultrasound findings, semen analysis, hormone profiles, and treatment information were collected, and the clinical outcomes were evaluated. Of 33 patients, 29 patients were retrospectively analyzed. Vasoepididymostomy (VE) or cross VE was performed in 12 patients, the patency rate was 41.7% (5/12), and natural pregnancy was achieved in one of the patients. The other 17 patients underwent testicular sperm extraction as the distal vas deferens (contralateral side) was obstructed. These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA, even with a relatively low rate of patency and natural pregnancy.

A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy / 亚洲男科学杂志(英文版)

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.

Do retractile testes have anatomical anomalies?

ABSTRACT Objectives: To assess the incidence of anatomical anomalies in patients with retractile testis. Materials and Methods: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p <0.05). Results: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). Conclusions: Retractile testis is not a normal variant with a significant risk of patent processus vaginalis and epididymal anomalies.

Bilateral isolated Epididymal Agenesis in a 32 year old man

Epididymal agenesis is defined as the absence of the epididymis totally or segmentally, unilateral or bilateral, which is secondary to the Wolffian duct malformation (1). Rete testis, epididymis, vas deferens and seminal vesicle are believed to develop from Wolffian ducts.

Sperm analysis of the vas deferens fluid after a long interval of unilateral percutaneous epididymal sperm aspiration in vasectomized patients

Objectives Evaluation of the presence of spermatozoa in vas deferens fluid after a long interval of unilateral and homolateral percutaneous epididymal sperm aspiration (PESA) in vasectomized men. When found, the spermatozoa were evaluated including concentration and motility, in order to verify the patency of the epididymal tubules. Materials and Methods Four patients, numbered in a progressive order, from one to four, with 38, 40, 48 and 51 years old and vasectomy interval of 10, 10, 25 and 11 years, respectively, whose wives did not get pregnant using intracytoplasmic sperm injection of sperm obtained by unilateral PESA and decided to try only natural conception, were submitted to intrasurgical sperm analysis of the vas deferens fluid (ISAVDF) during microsurgery for reconstruction of the seminal tract. Results Time interval between PESA and ISAVDF was 13.75 ± 11.12 months (x ± s) varying from 3 to 29 months. Homolateral ISAVDF and PESA showed the presence of spermatozoa. Patients 1, 2 and 4 had a high concentration of 10 x 106, 64 x 106 and 45 x 106 spermatozoa/ mL; the first two had motile sperms and patient 3 had no sperms. Conclusions Three of four patients showed spermatozoa in the vas deferens fluid after a long interval of unilateral and homolateral PESA with high concentration, including motile forms. These findings support the concept that PESA may not result in late epipidymal tubule obstruction in vasectomized patients. .

Obstructive azoospermia: reconstructive techniques and results

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.

An update on sperm retrieval techniques for azoospermic males

The use of non-ejaculated sperm coupled with intracytoplasmic sperm injection has become a globally established procedure for couples with azoospermic male partners who wish to have biological offspring. Surgical methods have been developed to retrieve spermatozoa from the epididymides and the testes of such patients. This article reviews the methods currently available for sperm acquisition in azoospermia, with a particular focus on the perioperative, anesthetic and technical aspects of these procedures. A critical analysis of the advantages and disadvantages of these sperm retrieval methods is provided, including the authors' methods of choice and anesthesia preferences.

Long-term effects of the testicular torsion on the spermatogenesis of the contralateral testis and the preventive value of the twisted testis orchiepididymectomy / Efeitos tardios da torção testicular sobre a espermatogênese do testículo contralateral e o valor preventivo da orquiepididimectomia do testículo torcido

PURPOSE: To determine whether the testicular torsion causes long-term effects on the spermatogenesis of the contralateral testis, and whether the orchiepididymectomy of the twisted testis could prevent them, using specific spermatogenesis parameters to elucidate the conflicting results in the literature. METHODS: Seventy-four pubertal male Wistar rats were randomly selected. The experimental group consisted of 40 rats, divided into four subgroups, submitted to 1.080 degrees counterclockwise left testicular torsion and its scrotal fixation at the beginning of the experiment, and left orchiepididymectomy at one, five, ten and 90 days, respectively. The control group consisted of 24 rats, divided into four sham operation control subgroups. An additional control subgroup consisted of the ten remaining rats, submitted only to the left orchiepididymectomy at the beginning. At 90 days, the contralateral testes of the experimental and control subgroups were collected for the evaluation of their spermatogenesis parameters: testicular weight, seminiferous tubular diameter, Johnsen score and differential counting of the germ cells. RESULTS: No statistically significant differences were observed among the experimental and control subgroups for all of the spermatogenesis parameters of the contralateral testes. CONCLUSIONS: Testicular torsion does not cause long-term effects on the spermatogenesis of the contralateral testis in pubertal rats, and the orchiepididymectomy of the twisted testis is not necessary for preventive purposes for the contralateral spermatogenesis.

OBJETIVO: Determinar se a torção testicular causa efeitos tardios sobre a espermatogênese do testículo contralateral e se a orquiepididimectomia do testículo torcido poderia preveni-los, usando parâmetros específicos da espermatogênese para elucidar os resultados conflitantes na literatura. MÉTODOS: Foram selecionados aleatoriamente 74 ratos machos púberes da linhagem Wistar. O grupo experimental foi composto por 40 ratos divididos em quatro subgrupos, submetidos à torção anti-horária de 1,080 graus do testículo esquerdo e sua fixação escrotal no início do experimento e à orquiepidimectomia esquerda com um, cinco, dez e 90 dias, respectivamente. O grupo controle foi composto por 24 ratos divididos em quatro subgrupos de cirurgias simuladas. Um subgrupo controle adicional foi constituído pelos dez ratos restantes submetidos unicamente à orquiepididimectomia esquerda no início do experimento. Aos 90 dias, os testículos contralaterais dos subgrupos experimentais e controles foram coletados para avaliação dos parâmetros de suas espermatogêneses: peso testicular, diâmetro do túbulo seminífero, graduação de Johnsen e contagem diferencial das células germinativas. RESULTADOS: Não houve diferença estatisticamente significativa entre todos os subgrupos experimentais e controles para todos os parâmetros analisados da espermatogênese dos testículos contralaterais. CONCLUSÕES: A torção testicular não causa efeitos tardios sobre a espermatogênese do testículo contralateral em ratos púberes e a orquiepididimectomia do testículo torcido não é necessária para fins preventivos da espermatogênese contralateral.

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69 percent) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53 percent) cases, it was totally attached to the testis in 54 (37.76 percent) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Rabdomiosarcoma de epididimo / Epididymal Rhabdomyosarcoma

Se presenta un tumor mesenquimatoso maligno originado en las estructuras paratesticulares, que corresponde a un radiomiosarcoma de epidismo. Se destaca su baja incidencia en la literatura mundial y su manejo terapeútico multidisciplinario (cirugia, radioterapia, quimioterapia). Fue intervenido en el Servicio de Urología de Antártida Hospital Privado, en el año 1993 y se presenta su evaluación y seguimiento hasta la fecha

Pregnancies using sperm retrieved from the epididymis or extracted from the testis in two cases of obstructive azoospermia

Two men with obstructive azoospermia were treated by testicular exploration. Microscopic epididymal sperms aspiration [MESA] was used in the first patient and testicular epididymal sperms extraction [TESE] in the second. The sperms retrieved in each case were used for intracytoplasmic sperm injection [ICSI] of metaphase 2 oocytes obtained from their respective female partners. Clinical pregnancies were achieved in both cases

Scrotal exploration in 123 azoospermic patients: the results of survey for obstructive azoospermia

During the last eight years, scrotal exploration for attempted vasoepididymostomy was performed in 123 azoospermic patients at the King Faisal Specialist Hospital and Research Centre. All patients had normal or slightly elevated serum FSH, and normal-size testes [at least on one side]. Testicular biopsy was not recommended but had already been done before referral in 73 patients and was reported to show normal spermatogenesis or mild hypospermatogenesis. Vasoepididymostomy could be performed in only 83 [67.5%] patients using the conventional fistula technique in 34 patients and microsurgical single tubule anastomosis in 49 patients. Sixty-seven patients were followed between six and 30 months [mean 17.8 months]. Among these patients, 25 produced sperm in the ejaculate with a patency rate of 37.3 percent and seven patients impregnated their wives, for a pregnancy rate of 10.4%. These pregnancies resulted in four living children. The patency rate with the conventional fistula technique was [7/26] 26.9%, and with microsurgical technique [18/41] 43.9%; the difference is statistically significant. Microsurgical single tubule vasoepididymostomy is strongly recommended for the treatment of obstructive azoospermic patients, as it gives a higher percentage of successful anastomosis

Spermatic cord block: a safe technique for intrascrotal surgery

In this study, 48 patients underwent operative procedures on the testes, epididymis or the spermatic cord using the technique of spermatic cord block anesthesia. There were no complications attributable to the technique. The procedures were tolerated well and most of the patients were treated on a day case basis

Serum and semen levels of immunoreactive prolactin, LH and FSH in normospermic, oligospermic and azoospermic men with obstructive infertility prior to and after vasoepididymostomy.

Attempts were made to validate RIA for prolactin (PRL), LH and FSH in semen from normospermic, oligospermic and azoospermic subjects. The RIA used to measure PRL and LH in semen fulfilled the criteria of reliability, whereas low levels of FSH in semen precluded the validation of FSH assay in semen. Semen levels of PRL and LH were significantly (P < 0.05) higher than serum levels in all groups of subjects investigated. Semen levels of FSH in azoospermic men after vasoepididymostomy (VEA), were significantly (P < 0.05) higher compared to azoospermic men prior to surgery. Serum levels of PRL were significantly higher (P < 0.05) in normospermic men compared to oligospermic and azoospermic men prior to and after surgery. Semen levels of PRL in normospermic men were comparable with oligospermic and azoospermic subjects prior to and after surgery. Serum levels of LH in oligospermic and azoospermic men who did not undergo surgery and in men reporting oligospermia after VEA were comparable to normospermic subjects but in men showing azoospermia post surgically, serum LH levels were significantly (P < 0.005) elevated. Semen levels of LH in men reporting azoospermia before surgery and in subjects showing oligospermia or azoospermia post surgically were significantly lower (P < 0.05) compared to men with normal sperm count. Serum levels of FSH were significantly elevated (P < 0.05) compared to semen levels in oligospermic men prior to surgery but this increase was not seen in post VEA subjects. These results were discussed.

Anatomía microquirúrgico del epidímo / Microsurgical antaomy of the epididymis

La microcirugía epididimaria requiere un conocimiento profundo de anatomía de este órgano, poco conocida hasta la fecha. Se basa esta descripción anatómica en la disección microquirúrgica de epididimos normales en fresco, y en el estudio de cortes histológicos sagitales, frontales y transversales luego de su fijación en formol al 10%. Se describe macroscópicamente al epidídimo considerándolo clásicamente como una lámina delgada con dos caras, dos extremos y dos bordes, siendo éstos: el in interno fijo o vascular y el externo, libre o linfático. Lo conceptual de este trabajo se refiere a la descripción original de la sistematización microscópica del tubo epididimario denominándose a este: primario o simple. A su plicatura se la llam circunvolución de primer grado, y mediante ellas se organiza en una estructura alargada llamada columna epidimaria que en la cabeza es múltiple y en el cuerpo es única, describiendo en este un desarrollo helicoidal aplanado de forma prismática en volumen y de sección triangular llamado circunvolución de segundo grado. Se considera que esta descrición anatómica tiene gran utilidad para quienes practiquen microcirugía epididimaria o deseen iniciarse en ella, enfrentándola con la información adecuada sobre el tema, permitiendo mejores resultados prácticos en su ejecución