Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia (analysis of 49 case reports)

Abstract

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy (VE) in the treatment of epididymal obstructive azoospermia (EOA), we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy (LIVE) between 2000 and 2007. The data included the surgical method, postoperative motile sperm count per ejaculation, percentage of progressive motile sperm and patency and pregnancy outcomes. There were a total of 49 men undergoing scrotal exploration, and epididymal obstruction was found in all cases. Bilateral or unilateral anastomoses were performed in 40 and 6 men, respectively. The postoperative courses of 42 patients were followed up for more than 6 months, and the courses of 38 patients were followed up for more than 1 year. The overall patency and pregnancy rates were 71.4% and 26.3%, respectively. Moreover, progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput. Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis. We think that the loupe-assisted method, with a lower overall cost and a simplified surgical procedure, can achieve satisfactory patency outcomes and pregnancy results. Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

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

“…Herein, we discussed the modified single-armed 2-suture longitudinal intussusception vasoepididymostomy. The data were similar to the previously reported patency rate of 52–92% and the pregnancy rate of 11–56% [ 15 , 16 ]. In the present cohort, we evaluated the pre-, intra-, and postoperative variables of individual patients that might affect the outcomes of the modified SA-LIVE.…”

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

“…Here we are about to discuss the modified single-armed 2-suture longitudinal intussusception vasoepididymostomy. Our data are comparable to the previously reported patency rate of 52%-92% and the pregnancy rate of 11%-56% [12,13]. In the cohort, we evaluated pre-, intra-and postoperative variables of individual patients that might affect the outcomes of the modified SA-LIVE.…”

A modified single-armed technique for microsurgical vasoepididymostomy

“…The longitudinal style allows a wider opening in the epididymal tubule, which increases the chances of patency initially and in the long term, and this finding is supported by some subsequent studies. 2,3,11,12 These techniques usually use specialized double-armed sutures for the anastomosis, in which the needles are placed inside-out on the vas deferens to avoid back-walling the tubular lumen. However, these double-armed sutures are expensive and are difficult to acquire in some countries.…”