Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia:a tertiary care center experience

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.

High ligation of the hernia sac in open nonmesh inguinal herniorrhaphy is an important cause of iatrogenic vas deferens injury

Vasectomy damage is a common complication of open nonmesh hernia repair.This study was a retrospective analysis of the characteristics and possible causes of vas deferens injuries in patients exhibiting unilateral or bilateral vasal obstruction caused by open nonmesh inguinal herniorrhaphy.The site of the obstructed vas deferens was intraoperatively confirmed.Data,surgical methods,and patient outcomes were examined.The Anderson–Darling test was applied to test for Gaussian distribution of data.Fisher’s exact test or Mann–Whitney U test and unpaired t-test were used for statistical analyses.The mean age at operation was 7.23(standard deviation[s.d.]:2.09)years and the mean obstructive interval was 17.72(s.d.:2.73)years.Crossed(n=1)and inguinal(n=42)vasovasostomies were performed.The overall patency rate was 85.3%(29/34).Among the 43 enrolled patients(mean age:24.95[s.d.:2.20]years),73 sides of their inguinal regions were explored.The disconnected end of the vas deferens was found in the internal ring on 54 sides(74.0%),was found in the inguinal canal on 16 sides(21.9%),and was found in the pelvic cavity on 3 sides(4.1%).Location of the vas deferens injury did not significantly differ according to age at the time of hernia surgery(≥12 years or<12 years)or obstructive interval(≥15 years or<15 years).These results underscore that high ligation of the hernial sac warrants extra caution by surgeons during open nonmesh inguinal herniorrhaphy.

Sperm retrieval and intracytoplasmic sperm injection outcomes in men with cystic fibrosis disease versus congenital bilateral absence of the vas deferens

Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(ICSI)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and ICSI outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(P<0.05).The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,P<0.03)and lower fertilization rate with ICSI(32.5%vs 68.9%,P<0.01).In conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse ICSI outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.

近段输精管道获得性梗阻性无精子症经阴囊超声特征分析

目的探讨近段输精管道获得性梗阻性无精子症的经阴囊超声表现。方法对92例近段输精管道获得性梗阻性无精子症患者(病例组)行经阴囊超声检查,其中附睾炎性梗阻79例,输精管医源性梗阻13例(2例合并对侧附睾炎性梗阻),观察睾丸、附睾、阴囊段输精管的声像图表现。以65例精液检查正常者为对照组。结果病例组与对照组睾丸体积比较,差异无统计学意义(P>0.05)。92例患者184条附睾声像图均出现异常,其中附睾头、体、尾部的厚度与对照组比较,差异均有统计学意义(P<0.05);声像图表现为附睾整条或局部增厚,增厚部位附睾管扩张,呈细网状改变,附睾管内径为0.03 cm。39条(24.4%)炎性梗阻的附睾内合并出现炎性偏高回声结节。在160条附睾炎性梗阻的阴囊段输精管中,159条(99.4%)平均内径与对照组相同。24条医源性梗阻患者手术近端输精管均为扩张状态。结论近段输精管道获得性梗阻性无精子症由于梗阻的原因和部位不同,附睾与输精管存在不同特征的声像图表现,经阴囊超声可为该类疾病的诊断提供可靠的影像学依据。

显微外科技术下梗阻性无精子症术前诊断及治疗方式探讨

目的:探讨梗阻性无精子症(OA)在显微外科技术下术前诊断及其治疗策略。方法:57例不育症患者确诊为OA并初步怀疑为附睾梗阻,行阴囊探查术观察附睾及输精管梗阻情况;术中对确定为附睾梗阻并在附睾液中找到活精子的患者施行附睾输精管端侧吻合术,同时对探查至附睾头部才发现精子或术中发现双侧附睾以远输精管梗阻、缺如的患者留取精子冷冻以备卵细胞胞质内单精子注射(ICSI);术后随访其疗效。结果:53例(92.9%,53/57)行阴囊探查术确诊为附睾水平OA,47例(82.5%,47/57)完成显微手术,10例(17.5%,10/57)术中留取精子冷冻。22例(46.8%,22/47)于显微手术后1～18个月从精液中检出活动精子;5例(10.6%,5/47)配偶自然受孕成功,6例(18.5%,6/32)留取精子行ICSI后配偶怀孕。结论:在显微外科技术日益成熟下,OA的术前诊断应尽量采取无创的手段,在手术探查中进行梗阻部位的确诊及决定治疗方式。

单侧输精管缺如4例临床分析及文献复习

目的:先天性单侧输精管缺如(Congenital unilateral absence of vas deferens,CUAVD)临床上罕见,诊疗过程中需要我们及时细致体检以便明确诊断,同时需要对病人适当的管理,注意预防对侧输精管病变,若罹患输精管疾患应采取积极合理的治疗。方法:我们回顾了2011年5月～2012年1月诊治的4例CUAVD患者的临床资料,对每例进行分析、总结各自特点。结果:经分析发现,通过计算机辅助精液分析(CASA)、仔细地体检、经直肠超声可以区分梗阻部位以及引起少弱精症、无精症的原因。4例CUAVD病例中,超声发现患侧精囊腺发育不良或缺如。其中2例出现健侧输精管炎症,1例经抗炎治疗精液常规恢复。结论:对临床病人仔细体检,通过经直肠前列腺、精囊腺和射精管超声检查能够明确CUAVD的存在。因为只是经过门诊无创性的检查,即可以提供有效的确诊证据。如果患者一旦确诊为CUAVD,应告之患者预防健侧输精管发生梗阻的后果,并能积极预防,避免导致梗阻性无精。

80例输精管道梗阻性无精子症的临床诊断及治疗

目的：探讨输精管道梗阻性无精子症临床诊治情况,以期提高临床疗效。方法：选取2011年1月至2013年1月80例输精管道梗阻性无精子症患者为研究对象,从病因、临床表现、辅助检查和治疗等进行总结。结果：80例输精管道梗阻性无精子症病因中先天性占21例、后天性占55例、特异性因素4例,平均性成熟年龄为（17.3±3.4）岁,毛发和皮下脂肪异常多见,睾丸多可触及不同程度硬结和疼痛感,平均精液量为（1.5±1.1）mL,pH值为（7.9±1.6）,粘稠度呈米汤样31例,41例出现不液化情况,遗传学检查中b、c亚区缺失31例。80例患者阴囊探查见远睾输精管和射精管均通畅,其中49例在附睾切口溢液找到活精子,21例附睾尾部找到活精子,5例在附睾体部找到活精子,5例在附睾头部找到活精子,术后多数在6个月内出现活精子,精子数量（2～70）×10^9/L,精子活率（10～60）%,精子活力为Ⅰ～Ⅲ级,其中49例患者在治疗后6个月内配偶妊娠,29例12个月内出现妊娠,治疗后精液量、果糖、中性α葡糖苷糖较治疗前明显提高,治疗前后比较差异显著（P〈0.05）。结论：输精管道梗阻性无精子症临床诊断明确,经手术治疗后疗效满意。

无精子症的病因分析

目的：对无精子症的病因进行分析。方法：对本院收治的１５０ 例无精子症患者进行回顾性研究，根据体检第二性征是否正常、两侧睾丸体积大小是否均匀、生殖激素测定正常与否，以初步鉴别是输精管阻塞性无精子症还是睾丸源性无精子症，然后作进一步相关检查，明确梗阻或生精障碍的确切病因。结果：输精管阻塞及缺如 ４１ 例，占２７．３％ ；生精障碍 １０４ 例，占６９．３％ ；原因不明 ５例，占３．４％ 。结论：通过对无精子症病因的分析，可以最大限度地筛选出用手术或药物可治愈的病例。

腹股沟疝术后梗阻性无精子症17例临床诊治分析

目的总结医源性腹股沟区输精管损伤的临床特征和治疗经验。方法收集2014年1月至2018年6月就诊于本院有腹股沟疝手术史,且诊断为梗阻性无精子症患者17例,回顾总结其临床特征、手术探查情况和输精管损伤特征,随访观察显微镜下输精管吻合后中远期疗效。结果 17例患者中14例成功进行输精管端端吻合或输精管附睾吻合,术后随访(19.6±9.5)个月,13例患者精道复通成功,精子计数为(33.1±25.6)×10^6/L,配偶自然受孕成功者6例。结论有生育要求的梗阻性无精子症患者通过接受显微输精管吻合绝大部分可恢复精道再通。

显微输精管交叉吻合术治疗复杂性梗阻性无精子症效果观察

目的探讨显微输精管交叉吻合术对于复杂性梗阻性无精子症的临床治疗效果。方法回顾性分析我院收治的38例行显微输精管交叉吻合术治疗的梗阻性无精子症患者的临床资料。结果本研究38例患者行显微下输精管交叉吻合术,30例患者精液检查中发现精子,其中8例患者配偶受孕成功。结论显微下输精管交叉吻合术对于复杂性梗阻性无精子症治疗效果较好,值得临床推广。

阴囊超声用于选择梗阻性无精子症治疗方法

目的探讨阴囊超声对于选择梗阻性无精子症治疗方式的价值。方法前瞻性收集梗阻性无精子症患者93例行阴囊超声检查,观察附睾、输精管是否完整可见、有无扩张及钙化,测量扩张附睾管及输精管内径;根据后续治疗方式将其分为取精组(27例)和重建组(66例),比较2组病因及超声征象。采用ROC曲线评价超声参数用于筛选梗阻性无精子症治疗方式的临界值、敏感度、特异度、阳性预测值、阴性预测值和准确率。结果2组间附睾形态异常、输精管细小或缺失、钙化及附睾管内径差异存在统计学意义(P均<0.05),睾丸体积及输精管内径差异均无统计学意义(P均>0.05)。以附睾管内径0.55 mm为临界值筛选梗阻性无精子症治疗方式,其敏感度87.47%,特异度86.70%,阳性预测值77.82%,阴性预测值92.76%,准确率87.03%。结论阴囊超声对于选择梗阻性无精子症治疗方式具有重要临床意义。

人工贮精囊6例报告

目的：为解决先天性输精管缺如梗阻无精问题。方法：采用睾丸鞘膜、硅胶帽和硅胶管等材料制成人工贮精囊（artificialspermatocele，ASC）。结果：睾丸鞘膜4例，硅胶帽和硅胶管各1例，术中涂片均见精子，术后抽吸3例出现精子（2例2次，1例3次）、结论：为配合体外人工授精（IVF）或显微授精（ICSI），人工贮精囊是有前途的方法。

附睾输精管吻合术治疗梗阻性无精子症

目的探讨附睾输精管吻合术在梗阻性无精子症治疗中的作用.方法选择23例确诊为梗阻性无精子症并初步怀疑为附睾水平梗阻的患者进行阴囊探查,观察睾丸、附睾及输精管情况,对其中19例确定为附睾水平梗阻并在附睾液中找到活精子的患者用8-0尼龙线施行双侧或单侧附睾输精管端侧吻合术,术后随访其疗效.结果19例获随访8～34个月,9例(47%)于术后3～9个月从精液中检出活精子,其中5例配偶受孕成功.结论阴囊探查简单、易行,有助于梗阻性无精子症的诊断和治疗,附睾输精管吻合术治疗梗阻性无精子症取得初步效果,值得进一步探讨.