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

Abstract

This study aimed to evaluate the efficacy and safety of vasal vessel‐sparing modified single‐armed 2‐suture longitudinal intussusception vasoepididymostomy (SA‐LIVE) to epididymal obstructive azoospermia patients. Forty consecutive epididymal obstructive azoospermia cases, who underwent microsurgical vasoepididymostomy in Shanghai General Hospital from January 2019 to October 2019, were included in this study. Twenty cases underwent SA‐LIVE (group A), and 20 cases underwent vasal vessel‐sparing SA‐LIVE (group B). Until March 2021, the mean follow‐up period was 16.9 ± 4.1 (12–23) months. The overall patency rate was 82.5%, and 80% and 85% for group A and group B respectively. The mean time to achieve patency was 4.11 ± 2.74 months. The overall natural pregnancy rate was 51.5%(17/33) at the mean follow‐up of 16.9 months. The natural pregnancy rate was 50.0% for group A and 52.9% for group B (p > .05). At the time of 6 months post‐operation, the patency rate was 70% for group A and 80% for group B (p = .465); the natural pregnancy rate was 0% for group A and 31.3% for group B (p = .022). Vasal vessel‐sparing SA‐LIVE is safe and effective to achieve favourable patency and pregnancy rates. Preserving vasal vessel would improve natural pregnancy rate at a very early stage.

Outcomes of microsurgical vasoepididymostomy using intussusception technique: a systematic review and meta‑analysis

“…Among 273 retrieved articles, 25 met the eligibility criteria and were included in the system review 2 , 5 – 28 . A PRISM flow chart describing the results of study identification and selection is shown in Fig.…”

Current progress on the curative effects of vasoepididymostomy for patients with obstructive azoospermia: An updated systematic review and meta‐analysis of human studies

“…All included studies were published between 1978 and 2021, with a cohort size ranging from 8 to 255 patients. Among them, 16 studies were conducted in China, five in Japan, 15 in America, four in India, two in Korea, two in Sweden, two in Saudi Arabia, one in Canada, one in Belgium, one in Egypt, one in Romania, and one in Slovenia, 4–9,12–56 and Table S1.…”

“…Some good surgical experiences in the included studies are noteworthy and learning for improving the success rates of MVE in our clinical work. First, operators should free the proper length of the vas deferens to achieve tension‐free anastomosis 19,50,56 . Second, operators should save, as far as possible, the vas deferential artery and protect the blood supply to the testis 19,50,56 .…”

“…First, operators should free the proper length of the vas deferens to achieve tension‐free anastomosis 19,50,56 . Second, operators should save, as far as possible, the vas deferential artery and protect the blood supply to the testis 19,50,56 . Third, the anastomotic site should contain motile sperm in the epididymal fluid 36,9 .…”

“…19,50,56 Second, operators should save, as far as possible, the vas deferential artery and protect the blood supply to the testis. 19,50,56 Third, the anastomotic site should contain motile sperm in the epididymal fluid. 36,9 Finally, operators should avoid as far as possible the leakage of sperms from the anastomosis, thereby reducing the risk of sperm granulomas and inflammation.…”