Modification of microsurgical longitudinal intussusception technique of vaso-epididymal anastomosis: A single-center experience

Abstract

Purpose:Microsurgical intussusception vasoepididymostomy (VE) is well-established treatment option for obstructive azoospermia due to epididymal obstruction. In this study, we evaluated patency rates and complications of our modified longitudinal intussusception technique of microsurgical VE. We have modified the intussusception technique by taking only adventitia of epididymal tubule.Methods:This was a prospective, single-center (tertiary care center) study conducted from February 2008 to January 2016. Study patients were men aged more than 18 years with infertility due to azoospermia. All participants underwent microscopic VE with our modified intussusception technique. Patency rates, complications, and improvement in semen quality were assessed.Results:A total of 42 patients were included in the study and underwent unilateral VE using longitudinal intussusceptions technique. The mean age of the patients was 30.21 years. Of these 42 patients, 40 patients had congenital obstruction. Average operative time was 130.42 min. A total of 36 (85.7%) patients had motile sperms in the epididymal fluid. Patency at 3 months was observed in 25 (62.5%) patients with an average sperm count of 17.1 million/mL. Only two patients (5%) had hemotoma at the site of surgery.Conclusion:Our modified technique of microsurgical longitudinal intussusception VE using epididymal adventitial stitch showed a reasonable patency rate after surgery.

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.…”

Comparative evaluation of double- and single-armed two-suture longitudinal intussusception techniques in microsurgical vasoepididymostomy: An updated systematic review and meta-analysis

“…Fig 4 shows different patency criteria for the patency rate. The mean patency rate was 65% (95% CI, 59–71%) when the patency criterion was the presence of any sperm in the semen [ 3 , 6 , 13 , 16 , 17 , 20 , 22 , 24 , 27 , 28 , 30 ]. When the patency criterion was sperm concentration >10 thousand/ml [ 4 , 5 , 11 , 15 , 21 , 25 , 26 ] or >1 million /ml [ 7 , 8 ], the mean patency rate was 71% (95% CI, 65–77%) and 69% (95% CI, 42–95%), respectively.…”

“…Of the 489 articles identified, 24 studies were eligible and included in the meta-analysis [3][4][5][6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. This study's identification and selection process is illustrated in Fig 1 (S1 and S2 Files), according to the PRISMA flow chart.…”

Unilateral Versus Bilateral Vasoepididymal Anastomosis for Idiopathic Obstructive Azoospermia: A Randomised Controlled Trial

“…The two-suture intussusception technique of a VEA was first described by Marmar [13] in 2000, and they reported a patency rate of 81.3% in 16 patients. Since then, many modifications have been described, with patency rates ranging from 48% to 81% [6] , [14] , [15] , [16] , [17] . In the present study, we found an overall patency rate of only 36.5%, with 46% patency in patients undergoing bilateral surgery.…”