Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia(analysis of 49 case reports)

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy(LIVE)between 2000 and 2007.The data included the surgical method,postoperative motile sperm count per ejaculation,percentage of progressive motile sperm and patency and pregnancy outcomes.There were a total of 49 men undergoing scrotal exploration,and epididymal obstruction was found in all cases.Bilateral or unilateral anastomoses were performed in 40 and 6 men,respectively.The postoperative courses of 42 patients were followed up for more than 6 months,and the courses of 38 patients were followed up for more than 1 year.The overall patency and pregnancy rates were 71.4%and 26.3%,respectively.Moreover,progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput.Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis.We think that the loupe-assisted method,with a lower overall cost and a simplified surgical procedure,can achieve satisfactory patency outcomes and pregnancy results.Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

The effect of BMI and age on the outcomes of microsurgical vasoepididymostomy: a retrospective analysis of 181 patients operated by a single surgeon

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.