Multifactor analysis of postoperative patency of microsurgical vasoepididymostomy / 中华泌尿外科杂志

ABSTRACT

Objective To analyze the factors which may affect postoperative patency of microsurgical vasoepididymostomy (VE).Methods Ninety-four patients underwent VEs from September 2014 to June 2016 in the Department of Urology,Peking University Third Hospital,with average age of (30.7 ± 4.8) years,and body mass index (BMI) of (25.1 ± 3.0) kg/m2.Semen analyses were performed 1 month,3 months and 5 to 6 months after the operation.The following semen analyses were performed every 3-6 months thereafter.Patency was defined by finding sperms in twice or more analyses during the followup until August 2017.Patients were followed up by face-to-face or telephone interview.Seven factors (age,BMI,bilateral or unilateral anastomosis,anastomosis sites,the adjustment of anastomosis sites,motility and quantity of sperms found in epididymal fluid) were analyzed by Chi-square analysis and multifactor logistic regression analysis.Results Eighty-two patients were followed up (87.2％,82/94) while 12 patients were lost of follow-up.The mean follow-up time was 19 months.Sperms were found in the ejaculate in 59 patients postoperatively.The overall patency rate was 72.0％ (59/82),and natural paternity rate was 32.8％ (19/58).Patients ≤28 years old and those ＞28 years old had patency rates of 89.3％ (25/28) and 63.0％ (34/54,P =0.012),respectively.Patients with BMI ＜26.0 kg/m2 and BMI≥26.0 kg/m2 had patency rates of 80.4％ (41/51) and 58.1％ (18/31,P =0.029),respectively.Patency rate of bilateral surgery was 72.1％ (44/61) and of unilateral surgery was 71.4％ (44/62,P =0.727).Patency rate of caput anastomosis achieved 75.0％ (15/20) and of corpus/caudal anastomosis was 71.0％ (44/62,P =0.727).Patency rates of patients with and without adjustment of anastomosis sites were 77.8％ (7/9) and 71.2％ (52/73,P =0.680),respectively.Patency rates of a lot,a few,motile and seldom-motile sperms in epididymal fluid were 74.3％ (55/74) vs.50.0％ (4/8,P =0.146) and 70.0％ (28/40) vs.73.8％ (31/42,P =0.701),respectively.Multifactor logistic regression analysis showed that age was well associated with patency rate (OR=4.705,95％CI 1.181-18.742,P=0.028).Conclusions Age ≤28 years is an independent factor leading to higher patency rates.Patients with lower BMIs and younger could have higher patency rates.Factors of anastomosis sides,anastomosis sites,the adjustment of anastomosis sites,motility and quantity of sperms found in epididymal fluid showed no statistical difference in patency rates.