Multiple factors affecting surgical outcomes and patency rates in use of single-armed two-suture microsurgical vasoepididymostomy: a single surgeon′s experience with 81 patients

Abstract

Vasoepididymostomy (VE), as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong (KH). At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 (2-17) months. The patency rate was 66.1% (41/62). Natural pregnancy rate was 34.1% (14/41). Overall pregnancy rate was 22.6% (14/62). No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate: anastomosis sites (P = 0.035) and motile sperm found in the epididymal fluid (P = 0.006). Motile sperm found in the epididymal fluid were associated with a higher patency rate (OR = 11.80, 95% CI = 1.79, 77.65). The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.

A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy

“…Some factors, such as the etiology of the epididymal obstruction, anastomotic site, and presence of motile sperm in the epididymal fluid, have been shown to be related to the patency rate. 5 16 However, in this study, there were no significant associations between the patency rate and these predictors ( P > 0.05; Table 3 ).…”

“…In Western countries, most epididymal obstructions are secondary to vasectomy, whereas epididymal obstructions in China are more often caused by infection or idiopathic factors. 4 5 15 16 In our series, 56.5% (39/69) of patients had a previous identifiable infection, including 38 patients with a history of epididymitis and one patient with a history of urethritis.…”

“…MVE techniques have continued to evolve and improve since 1998, with LIVE becoming the gold standard. 4 5 6 7 15 16 17 18 19 In our previous studies, we described a modified single-armed suture technique for LIVE and achieved a patency rate of 61.5% in men with epididymal obstructive azoospermia. 5 6 …”

“Through Thick and Thin:” Morphological spectrum of epididymal tubules in obstructive azoospermia

“…Use of microsurgical technology, performance of bilateral anastomosis, corpus or caudal anastomosis, and motile sperm in the effluent are associated with the improvement in patency rate postoperatively. [ 1 4 5 ] The tubule diameter has not been objectively studied as prognostic factor for VEA. However, the fact that the tubule diameter is largest in the body and tail and the consequential higher success rate provides an indirect evidence for the same.…”

“…The infective and idiopathic etiology is much more frequently encountered in the literature from Asian countries when compared from the Western literature where the most common cause of such obstruction is postvasectomy. [ 4 ] To the best of our knowledge, it is one of the first pictographic descriptions of the morphological variation of the epididymal tubules during VEA and contributes to the literature of male infertility.…”