Surgical procedures for male infertility: an update

Abstract

Purpose of review The aim of this review is to provide an overview of surgical treatment options for male infertility including varicocelectomy, treatment of ejaculatory duct obstruction, vasovasostomy, and sperm extraction, and to review recent advances in techniques and technologies that may improve operative outcomes. Recent findings Microscopic subinguinal varicocelectomy has been shown to have the highest success rates with lowest rates of complications, and may be facilitated by the use of Doppler, indocyanine green angiography, and the 4K3D operating video microscope. The standard treatment for ejaculatory duct obstruction by transurethral resection of the ejaculatory ducts has changed little over time, but vesiculoscopy may allow for temporary dilation of an obstruction to allow for natural conception, while also offering diagnostic capabilities. Use of the robotic platform has gained popularity for vasectomy reversals but controversy remains regarding the cost-effectiveness of this option. Recently, a reinforcing suture technique has been described for vasovasostomy to minimize anastomotic breakdown and reversal failure. Finally, gray-scale and color-enhanced ultrasound may improve ability to predict successful sperm retrieval during extraction procedures. Summary Though the fundamentals of surgical treatment options for male infertility have changed little with time, technological advancements have contributed to improved surgical outcomes over recent years.

Hypomorphic and hypermorphic mouse models of Fsip2 indicate its dosage-dependent roles in sperm tail and acrosome formation

“…Male infertility is a major issue in human reproductive health, affecting more than 20 million men worldwide and preventing natural conception (Niederberger, 2020;Visser et al, 2020). Asthenozoospermia, a symptom frequently observed in infertile men with less progressive motile sperm (Cooper et al, 2010), is caused by morphological and functional defects of the sperm flagellum.…”

Transurethral resection of ejaculatory ducts (TURED) for the management of ejaculatory duct obstruction: a Saudi cohort

“…Several retrospective studies have reported improved semen parameters in 50-65% of infertility cases and a pregnancy rate of 20-30% following TURED [1]. Although TURED is endorsed as a treatment for EDO and performed by urologists for male fertility and oncologic cases [2,3], its effectiveness is not well understood, and further research is necessary to ascertain the specific patient subgroups that will derive the most benefit from this procedure.…”

Cosmetic outcomes of improved microscopic subinguinal varicocelectomy in patients with varicoceles

“…Presently, the treatment of VCs can be divided into two categories: surgical treatment and interventional treatment. Although each approach has advantages and complications, the incidence of hydroceles and recurrence rate after MSV are the lowest [3] . Based on MSV, some improvements were made using the natural folds of the scrotal skin, and some unexpected benefits were obtained.…”