Microsurgical Repair of Iatrogenic Injury to the Vas Deferens

Sheynkin, Yefim; Hendin, Benjamin N.; Schlegel, Peter N.; Goldstein, Marc

doi:10.1016/s0022-5347(01)64036-9

Cited by 120 publications

(69 citation statements)

References 9 publications

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“…In the most common scenario, an unrecognized injury is revealed only years later in the evaluation of subfertile or azoospermic men who underwent hernia repair during childhood. 7,[9][10][11] Unlike in adults, inguinal hernia repair in children is the most common cause of injury to the vas deferens, 9 which is more delicate and attenuated in infants. Early reports suggested that vasal injury occurs in 0.8% to 2% of pediatric hernia cases.…”

Section: Discussionmentioning

confidence: 99%

Vasal Injury During Inguinal Herniorrhaphy: A Case Report and Review of the Literature

Flechner¹,

Smith

Treseler

et al. 2014

TPJ

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Section: Discussionmentioning

confidence: 99%

Vasal Injury During Inguinal Herniorrhaphy: A Case Report and Review of the Literature

Flechner¹,

Smith

Treseler

et al. 2014

TPJ

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“…Due to a variety of factors, most commonly divorce and remarriage, 3% to 8% of vasectomized men request reversal [99,100]. Injury to the vas is also a common cause of obstruction, most often the result of childhood hernia repair, orchiopexy, or hydrocelectomy [101].…”

Section: Obstructionmentioning

confidence: 99%

Gastrointestinal Endoscopy and Pathologic Findings

2011

Clinical Management of Intestinal Failure

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Medical treatment for male infertility generally falls under two categories: specific therapy and empiric therapy. In approaching a patient, it is practical to first seek a clear etiology to which a specific strategy can be applied rather than using medication for all infertile patients. When a cause cannot be identified, several hormonal therapies are available. It is difficult to predict who will respond to empiric hormonal treatment of idiopathic infertility, but this choice may prove valuable in conjunction with advanced assisted reproductive techniques. Specific therapy GonadotropinsHypogonadotropic hypogonadism accounts for less than 1% of all cases of male infertility and is discussed in great detail by Layman elsewhere in this issue. Gonadotropin replacement is the rational treatment and is the only clearly accepted and effective management of associated infertility. Normal male fertility requires adequate levels of intratesticular testosterone and follicle-stimulating hormone (FSH); the latter has been shown to initiate and maintain spermatogenesis [1,2]. FSH administered to men who have hypogonadotropic hypogonadism has demonstrated increases in sperm count, motility, morphology, and testicular volume [3]. Thus, it has been postulated that treatment solely with FSH may be adequate, however prolonged.

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“…18 However, epididymal blockage is not uncommonly found, due to either clinically obvious or clinically unrecognized epididymitis and, on rare occasions, due to Young's syndrome. [19][20][21] Prior hernia repair or pelvic surgery may be the inciting event in vasal injury. The histories, therefore, of epididymitis, hernia repair, scrotal surgery, chronic bronchitis, etc.…”

Section: The Medical and Surgical History: What Clues Might It Reveal?mentioning

confidence: 99%

“…It is important to be aware that the reference ranges of commercial kits are not based on the analysis of normozoospermic fertile men, but on the general population with different reproductive and age characteristics. The most accurate 'normal' value is based on the median FSH levels measured in normozoospermic men and corresponds to 1.5-8 IU l 21 . As spermatogenesis deteriorates and Sertoli cell output of inhibin wanes, there is a compensatory rise in pituitary elaboration of FSH such that the serum value ascends above the lower aspect of the 'reference range'.…”

Section: Hormonal Studies: Which Ones Should Be Ordered and How Do Thmentioning

confidence: 99%

Evaluation of the azoospermic male

2008

Fertility and Sterility

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When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to have in mind when embarking on the evaluation. Adjunctive laboratory tests, such as hormonal assays or genetic studies, are often complementary and/or additive and allow a very precise determination to be made as to the etiologies, either genetic or acquired. It is only with this information that a therapeutic plan can be made for the patient. As will be discussed, a targeted approach to testing is far more satisfying and cost-effective than a blind, shotgun approach. INTRODUCTIONIn most circumstances, azoospermia is diagnosed when no spermatozoa are detected upon microscopic evaluation of two centrifuged semen samples. As will be seen below, certain conditions only require a single semen specimen when coupled with history, physical examination or both. Azoospermia is found in approximately 1% of all men and up to 15% of infertile men, depending upon the demographic nature of the infertile cohort. 1 Aspermia is defined as a complete absence of seminal fluid during orgasm. Men with azoospermia should be evaluated in an effort to discover the underlying etiology of their condition, which will guide the formulation of a therapeutic plan. 2 A complete history and physical examination is mandatory, while measurement of reproductive hormones (testosterone, folliclestimulating hormone (FSH), luteinizing hormone (LH), prolactin and estradiol) are potentially helpful. Depending upon the certain or suspected diagnosis, a Y chromosomal microdeletion assay, a karyotype, cystic fibrosis mutation analysis, transrectal ultrasonography and renal ultrasonography may be helpful. There should be no single 'azoospermia panel' where all of these studies are ordered in a shotgun approach with no regard to the likely diagnosis. These adjunctive tests are ordered in a targeted way-only those that are necessary based upon the presumptive diagnosis are obtained. This presumptive diagnosis is arrived at by the evaluating clinician with a combination of the mind (what do the history, the semen analysis and the hormonal data suggest), the eyes (what does the patient's appearance suggest) and the fingers (what does the genital physical examination suggest). To be clear in one's thoughts, though, it requires a way of thinking about azoospermia, a process to focus on and an algorithm to follow.

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Microsurgical Repair of Iatrogenic Injury to the Vas Deferens

Cited by 120 publications

References 9 publications

Vasal Injury During Inguinal Herniorrhaphy: A Case Report and Review of the Literature

Vasal Injury During Inguinal Herniorrhaphy: A Case Report and Review of the Literature

Gastrointestinal Endoscopy and Pathologic Findings

Evaluation of the azoospermic male

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