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

Nachuan Liu,Ruhui Tian,Huixing Chen,Yuhua Huang,Chencheng Yao,Erlei Zhi,Yuexin Yu,Zheng Li,Liangyu Zhao,Peng Li,Chao Yang

doi:10.1186/s12894-020-00692-5

Abstract

BackgroundTo evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE).MethodsFrom March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3–36) months.ResultsPatency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9, 40.7, 36.4, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11 ± 2.74 months. In the first 6 months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3–36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis.ConclusionModified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within 1 year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.

Highlights

To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE)
Subjects and laboratory examination From March 2015 to December 2018, 158 patients who suffered from epididymal obstruction azoospermia (EOA) underwent VE surgery in our center
From March 2015 to December 2018, a total of 158 patients diagnosed with an epididymal obstruction underwent modified Modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE) in our center; among these, 134 were followed up in a prospective study

Summary

Introduction

To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Microsurgical vasoepididymostomy (MVE) has been established as a more cost-effective alternative for men with obstructive azoospermia than direct assisted reproductive techniques (ART) [4]. Cornell et al first reported that the single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE) was similar to that of the double-armed procedure in an animal study [5]. Zhao et al reported the modified single-armed VE technique with favorable patency in a human study trial [6]. In the present study, we aimed to evaluate the fertility outcomes of MVE in 134 males with epididymal obstruction and identify the putative predictors for natural pregnancy. Novel intraoperative procedures and decision-making post-operation were explored

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