Results of 1,469 Microsurgical Vasectomy Reversals by the Vasovasostomy Study Group

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.

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 70%

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

Zhang¹,

Wei²,

Xu³

et al. 2009

“…The time since the vasectomy also correlates with the likelihood of epididymal obstruction. [11][12][13][14][15][16] Most investigators believe that vasectomy performed more than 5 years, particularly those without a vasal sperm granuloma or a long vasal chimney, has a significant likelihood of requiring a VE on at least one side.…”

Section: Evaluations and Diagnosismentioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

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.

“…12,13 The pregnancy rate decreases with increasing time between obstruction of the reproductive tract and its surgical reversal, suggesting that sequelae to the male reproductive tract increases with time after surgical reversal. [14][15][16] This study tried to demonstrate the expression change of epididymal proteins after obstruction and its surgical reversal. Image analysis of 2-D autoradiograms demonstrated that the total integrated intensity and total spot area of autoradiograms showed a consistent downward trend after reproductive tract obstruction, and this trend remained after patency.…”

Section: Discussionmentioning

confidence: 99%

Influence of reproductive tract obstruction on expression of epididymal proteins and their restoration after patency

Wang²,

Liu³

et al. 2012

Vasectomy is a simple and reliable method of male contraception. A growing number of men after vasectomy request vasectomy reversal due to various reasons. The pregnancy rate is lower than the patency rate after vasovasostomy and the pregnancy rate is time dependent. In this study, we evaluated the influence of reproductive tract obstruction on expression of epididymal proteins and their restoration after patency. Adult male Wistar rats were studied 30, 60 and 120 days after vasectomy, 30 days after vasovasostomy or after sham operations. Two-dimensional gel electrophoresis, mass-spectrometric technique, multidatabase search, Western blotting and real-time PCR were used to analyze the expression regulation of epididymal proteins. Total integrated intensity and total spot area of autoradiograms showed a consistent downward trend with time after obstruction, and this trend remained after patency. The intensity of the autoradiographic spots in three patency groups showed three trends: a downward trend, similar intensity and an upward trend compared with the correspondent obstruction group, respectively. Further verified experiments on human epididymis 2 (HE2), fertilization antigen-1 (FA-1), clusterin and PH20 demonstrated that compared with the correspondent obstruction group, the translation levels of HE2 and the mRNA transcription levels of HE2 showed an upward trend in patency groups, especially in the groups of obstruction for 60 days where the expression levels of HE2 were significantly upregulated after patency (P,0.05). Reproductive tract obstruction provokes a disregulation of gene expression in the epididymis and this disregulation remained after patency. Successful reversal may recover some proteins and the recovery is time dependent. Obstruction differentially alters mRNA transcription of different proteins and the content of proteins seemed to be easier to be influenced than the gene transcription. Vasovasostomy by modern microsurgical techniques remains the standard technique for vasectomy reversal with which all other methods of vasectomy reversal are compared. If success is defined that sperm can be detected in ejaculate following reversal, patency is over 80% in most microsurgical series, with patency approaching 100% in some reports. 1 However, pregnancies are obtained without assisted reproduction in 30%-75% of couples. 2 In other words, about 25% of couples are affected. Male factors account for about 50% of couples with infertility. 3 Approximately 10%-15% of infertile men suffer from azoospermia-complete absence of sperms in the ejaculate. Among these azoospermic patients, approximately 40% have complete obstruction in the ductal system and hence suffer from obstructive azoospermia. 4 Vasoepididymostomy is performed for congenital, infectious, postvasectomy or idiopathic epididymal obstruction. Following this type of microsurgery, 20%-40% of couples achieve pregnancy through intercourse without the assistance of reproductive techniques. 2 Similar to vasectomy reversal, the pregnancy rate is mu...