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

Abstract

Background：To evaluate the clinical outcomes and the time of sperm returning 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. Results: The mean follow-up period was 17 months (range 3-36 months). Patency was assessed by the return of sperm in the ejaculate. The overall patency rate is 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 it took to achieve patency is 4.11±2.74 months. And in the first six months, 87.8% (65/74) patency patients were reported to found sperm in the ejaculate. The overall pregnancy rate was 40.9 % (29/66) at the follow-up of 3 to 36 months, and the natural pregnancy rate was 30.3 % (20/66). The natural pregnancy rate was 32.1% for bilateral surgery, 33.3% for the site of distal anastomosis，but 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 ones may be a good choice. The expecting patency time is about within one year. Assisting with intraoperative sperm cryopreservation, patients can achieve better pregnancy outcomes. Moreover, the low natural pregnancy rate for the proximal anastomosis suggested that we should reconsider the indications of SA-LIVE for EOA patients. Key words: obstructive azoospermia; male infertility; vasoepididymostomy; patency; pregnancy