A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration

Abstract

Background: To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods: From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3-36) months. Results: Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9, 40.7, 36.4, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11 ± 2.74 months. In the first 6 months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3-36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis. Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within 1 year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.

Vasal vessel‐sparing microsurgical single‐armed vasoepididymostomy to epididymal obstructive azoospermia: A retrospective control study

“…In our previous study, we described there were no significant associations between the patency rate and predictors (such as anastomotic site) (Liu et al., 2020). Mean time to patency after VE ranged from 2.8 to 6.6 months (Farber et al., 2019), and the average time to achieve patency after modified SA‐LIVE was 4.11 ± 2.74 months (Liu et al., 2020). Compared with the group A (4.20 ± 1.55 months), there is a slight decrease on patency time in the group B (3.06 ± 1.88 months).…”

“…1% of men suffer from azoospermia, and OA accounts for about 40% of azoospermia, most of which are caused by EOA. In Western countries, most EOA is secondary to vasectomy, and in China, EOA is mostly caused by infection or idiopathic factors (Chen et al., 2016; Farber et al., 2019; Liu et al., 2020). In this study, 80% (32/40) of the patients had a history of urogenital infection, including 24 cases with epididymitis and 8 cases with urethritis.…”

“…The double‐armed suture LIVE is the standard golden management for the EOA (Chan, 2013). Furthermore, SA‐LIVE is an effective alternative when double armed sutures are not available (Monoski et al., 2007), and we modified the SA‐LIVE technique(Liu et al., 2020; Zhao et al., 2013). And Yuan et al also reported a novel double‐armed LIVE technique using only two single‐armed sutures, named Guo's SA‐LIVE (Yuan et al, 2020).…”

“…Then, the vasal vessel was carefully separated from the vas deferens for about 1 cm to free the tension (Figure 1, 2a). Subsequently, the anastomosis of the selected epididymal tubule and vas deferens was performed using the modified SA‐LIVE technique (Liu et al., 2020) (Figure 2b‐d). Sperm cryopreservation was performed using the LSL straw during the VE procedure as a backup.…”

“…Zhao et al (2013) reported a modified SA-LIVE procedure with a favourable patency rate in a human study trial. In our single-centre retrospective analysis of SA-LIVE, we managed to achieve a patency rate of 55.2% and natural pregnancy rate of 30.3% (Liu et al, 2020). We attempted to improve the rate of spontaneous pregnancy rate, constantly improved the surgical techniques and methods.…”