Intussusception Vasoepididymostomy With Longitudinal Suture Placement for Idiopathic Obstructive Azoospermia

Kumar, Rajeev; Mukherjee, Subhabrata; Gupta, Narmada P.

doi:10.1016/j.juro.2009.12.027

Cited by 46 publications

(44 citation statements)

References 12 publications

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“…13,21,29,30,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Most experts in this field agree that the technical experience of the surgeons is one of the most important factors for the success of VE. We reported our clinical experience of microsurgical LIVE in a series of 72 men with azoospermia due to epididymal obstruction.…”

Section: Discussionmentioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy (VE). Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE (LIVE) in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the preoperative evaluation along with the techniques of various VE will be described in this article.

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Section: Discussionmentioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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“…Our success rates have varied from under 40% to 80% in different sub-populations. [252627] These data suggest that outcomes in our patients may not be as unfavorable as generally perceived.…”

Section: Outcomes Reportingmentioning

confidence: 55%

Surgery for azoospermia in the Indian patient: Why is it different?

Kumar¹

2011

Indian J Urol

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Obstructive azoospermia is one of the few surgically correctable causes of male infertility. The outcomes of surgery in these patients are variable and often dependent upon the diagnosis and surgical expertise. We aimed to review the reported outcomes in Indian patients and evaluate potential reasons why these outcomes may be different from those reported from other regions. A search was performed on Medline/Pubmed using relevant keywords to identify publications from India on surgical management of azoospermia. The same search was repeated on Google and on the website of the Indian Journal of Urology. Personal emails were sent to prominent urologists performing surgery for azoospermia in India to obtain their opinions and reprints of their published articles. These were then reviewed. Very few articles were identified that pertained to the original search. A large majority of patients are diagnosed with idiopathic infertility. The outcomes of surgery where a clear diagnosis can be made are generally good and often comparable with the published literature. Infections are probably an under-diagnosed etiology. More research and publications are required to determine the etiology of obstructive azoospermia in the Indian men. These would help appropriate patient counseling and treatment.

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“…Surgical reconstruction is preferred over IVF if possible. [6] The possibility of surgical reconstruction depends on the presence of normal spermatogenesis in the testis.…”

Section: Discussionmentioning

confidence: 99%

Discordant clinical and histological findings predict failure of reconstruction in suspected obstructive azoospermia

2012

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Aims and Objectives:To analyze testicular histopathology in men diagnosed as idiopathic obstructive azoospermia (IOA) based on normal spermatogenesis on fine needle aspiration cytology (FNAC) but with absence of sperms in the epididymis during surgical exploration.Materials and Methods:Men presenting with infertility due to IOA during the study period from July 2008 to July 2010 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone (FSH), and testicular FNAC were done. Men with normal volume azoospermia with normal spermatogenesis on FNAC and palpable vas were offered scrotal exploration for microsurgical vasoepididymal anastomosis (VEA). Patients in whom reconstruction was not feasible intraoperatively were analyzed for the causes of failure. The FNAC, FSH and biopsy of these patients were compared.Results:77 men fulfilled the inclusion criteria. In 38 men, sperm was present in the epididymal fluid and VEA was performed. In 39 men, reconstruction was not feasible. Thirty-four of these 39 men had normal FSH and testicular volume. In 5 of these 39 men, serum FSH was high (mean 17.48 mIU/ml) and testes were small in size (mean volume 14.5 ml). Testicular biopsy in two of these five men showed patchy areas of atrophy, while the other three men had hyalinized seminiferous tubules with thickened basement membrane, maturation arrest and normal spermatogenesis, respectively.Conclusion:FNAC was discordant with histopathological examination (HPE) in four out of five patients of negative surgical exploration with raised FSH. Therefore, among men with idiopathic azoospermia, only those with both normal FSH and normal FNAC should be diagnosed as obstructive azoospermia and explored.

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Intussusception Vasoepididymostomy With Longitudinal Suture Placement for Idiopathic Obstructive Azoospermia

Abstract: Within 1 year after surgery approximately half of the men who underwent longitudinal vaso-epididymal anastomosis for idiopathic azoospermia had return of sperm in the ejaculate.

Cited by 46 publications

References 12 publications

The evolution and refinement of vasoepididymostomy techniques

The evolution and refinement of vasoepididymostomy techniques

Surgery for azoospermia in the Indian patient: Why is it different?

Discordant clinical and histological findings predict failure of reconstruction in suspected obstructive azoospermia

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