Male Reproductive Surgery Research Articles

Robot-assisted vasovasostomy and vasoepididymostomy: Current status and review of the literature.

Microscope-assisted vasovasostomy (MAVV) is a standard procedure used to reverse vasectomies. Robotic surgery has been established primarily for technically demanding urological procedures and has also been recently implemented in male reproductive surgery. We aimed to review the current evidence of robot-assisted vasovasostomy (RAVV) and robot-assisted vasoepididymostomy (RAVE). We performed a systematic literature review using PubMed to identify relevant original articles. We identified 2017 records through database search, and after removing duplicates, 782 records remained for further analysis. In total, 12 human and three animal studies were selected. Reported vasal patency rate ranges were 88%-100% for RAVVs and 55%-61% for RAVEs. The sperm count and postoperative pregnancy rates of RAVV ranged between 8.4 × 106-120 × 106 sperm/mL and 65%, respectively. Finally, procedure times in the human studies, recorded for extracorporeal RAVVs and RAVEs ranged from 97 to 238 minutes. Robot-assisted vasal reversal is feasible with similar patency rates as for the microsurgical approach and showing comparable outcomes. Additional benefits of this technique include improved vision and movement precision.

Re: Fertility-Enhancing Male Reproductive Surgery: Glimpses into the Past and Thoughts for the Future.

Re: Fertility-Enhancing Male Reproductive Surgery: Glimpses into the Past and Thoughts for the Future.

Fertility-enhancing male reproductive surgery: glimpses into the past and thoughts for the future

Over the past few decades, there have been numerous paradigm shifts in male reproductive surgery, resulting from a combination of technologic advancements in both the operating room and the laboratory. The operating microscope transformed the field of male reproductive surgery, enabling novel techniques and higher precision for the treatment of male-factor subfertility. The subsequent widespread adoption of microsurgical approaches was largely responsible for the emergence of a cadre of highly specialized male infertility microsurgeons. The advent and evolution of invitro fertilization/intracytoplasmic sperm injection was a concurrent story that further revolutionized the field. The ability to achieve fertilization and pregnancy with just a single sperm changed the ways in which male reproductive surgeons could approach a wide range of pathologies from obstructive to nonobstructive causes, culminating in the microdissection testicular sperm extraction procedure for the treatment of nonobstructive azoospermia. Here we review the recent advancements in fertility-enhancing male reproductive surgery for the treatment of four disease processes: varicocele, obstruction of the excurrent ductal system, ejaculatory duct obstruction, and nonobstructive azoospermia. While examining the great strides of the past, we look forward to exciting developments on the horizon.

Reproductive surgery: glimpses into the past and thoughts for the future (part 2)

This month's Views and Reviews continues with part two of the series regarding reproductive surgery. The roles of reproductive surgery in müllerian anomalies, tubal and pelvic disease, fertility preservation, and male reproductive surgery are included. Augmenting each contribution, authors have added images and videos to their reflections.

Re: Pros and Cons of Robotic Microsurgery as an Appropriate Approach to Male Reproductive Surgery for Vasectomy Reversal and Varicocele Repair.

Re: Pros and Cons of Robotic Microsurgery as an Appropriate Approach to Male Reproductive Surgery for Vasectomy Reversal and Varicocele Repair.

Changes in the incidence and uptake of reproductive surgery versus in vitro fertilisation in Australia between 2001 and 2015: A population-based study.

Improvements in success rates of assisted reproduction led to predictions that infertility surgery in both women and men would become extinct in developed countries. We sought to identify the changes in reproductive surgery that occurred between 2001 and 2015 to determine whether these predictions have been accurate. The Australian Institute of Health and Welfare (AIHW) national procedural dataset and the Australian Medicare Benefits Scheme (MBS) claims database were searched for procedure data for male and female reproductive surgery and assisted reproduction from January 2001 to December 2015. The denominators were based on annual point estimates of the total population aged 25-44years (female) and 25-55years (male) from the Australian Bureau of Statistics (ABS). This dataset provides procedures undertaken but not their indications. Over the study period the incidence of tubal surgery fell by 66%, vasectomy reversal by 33%, and surgical varicocoelectomy by 50%. In contrast, the rate of hysteroscopic myomectomy increased by 48%, hysteroscopic septoplasty by 125%, and laparoscopy for severe endometriosis increased by 84%. In vitro fertilisation oocyte retrievals increased by 90%. The rate of abdominal myomectomy was unchanged. Fertility surgery is not dead but has evolved.

Frequency of the Male Infertility Evaluation: Data from the National Survey of Family Growth

An estimated 7 million American couples per year seek infertility care in the United States. A male factor contributes to 50% of cases but it is unclear what proportion of infertile couples undergoes male evaluation. We analyzed data from cycles 5 to 7 of the National Survey of Family Growth performed by the Centers for Disease Control to determine the frequency of a male infertility evaluation, and associated reproductive and demographic factors. A total of 25,846 women and 11,067 men were surveyed. Male evaluation was not completed in 18% of couples when the male partner was asked vs 27% when female partners were asked. This corresponds to approximately 370,000 to 860,000 men in the population who were not evaluated at the time of infertility evaluation. Longer infertility duration and white race were associated with increased odds of male infertility evaluation. The male and female samples showed no change in the receipt of male examination with time. Many men from infertile couples do not undergo male evaluation in the United States. Given the potential implications to reproductive goals and male health, further examination of this pattern is warranted.

Fifteen‐year trend in the use of male reproductive surgery: analysis of the healthcare cost and utilization project data

• To determine trends in male reproductive surgeries. • A database analysis was performed using the Healthcare Cost and Utilization Project databases from 1988, 1992 and 1998-2002. SAS statistical software was used to estimate the total numbers of reproductive surgeries and their variances for each year. • The number of male reproductive surgeries has declined during the period of study, both in the inpatient and outpatient arenas. The number of procedures with a diagnosis of infertility has also declined. • The number of male reproductive surgeries has declined from 1988 to 2002.

Stereological analysis of the human testis after vasectomy indicates impairment of spermatogenic efficiency with increasing obstructive interval

Objective To quantify germ cell loss and the extent of testicular fibrosis in vasectomized patients of varying obstructive intervals. Design : Retrospective study. Setting Specialized male reproductive surgery and endocrinology service. Patient(s) Thirty-four vasectomized patients 1–20 years after surgery and 10 normal subjects. Intervention(s) Thirty-four testicular biopsies taken at the time of vasectomy reversal (vasovasostomy). Control biopsies taken from 10 normal men at the time of vasectomy. Main outcome measure(s) Stereological assessment of testicular germ cell populations and testicular fibrosis. Result(s) Vasectomy caused a significant decrease in germ cells in the later stages of spermatogenesis, with significant reductions in pachytene spermatocytes (by 18%), round spermatids (by 40%), elongating spermatids (by 23%), and elongated spermatids (by 39%). The loss of spermatids showed a significant relationship with obstructive interval. A significant 2.7-fold increase in total (peritubular plus interstitial) fibrosis was observed, which showed a positive relationship with obstructive interval. Decreased germ cell populations and fibrosis did not seem to be related to sperm antibody levels nor to sperm counts obtained up to 2 years after vasovasostomy. Conclusion(s) Vasal obstruction results in significant reductions in germ cells in the later stages of spermatogenesis and increases in testicular fibrosis, both worsening with an increasing obstructive interval. Testicular damage after vasectomy might impact upon the prospects for reversal.

Male Reproductive Surgery

Although male reproductive surgery can be very rewarding, it is overall a bad area to do surgery. To have a successful outcome there must be complete freedom of movement. The area is prone to post operative swelling and the area is contaminated, which increases the risk of post operative infection. Post operative infection leads to abscesses which lead to secondary adhesions as they heal. With these factors in mind a guarded prognosis is in order and these surgeries should only be considered on valuable animals.
 Urogenital surgery requires a lot of time, not only from a surgical standpoint, but also extended time out of service post-operatively. Depending on the surgical procedure at least 30 days of sexual rest is recommended. In most cases this removes a bull from the program for an entire breeding season.
 Tranquilizers should be avoided when performing urogenital surgery as many of them cause the penis and prepuce to prolapse. Prolapse increases edema to the injured part and may lead to secondary trauma. Therefore, if tranquilization is necessary it should be done lightly and with caution.

Atlas of Anesthesia Volume V: Subspecialty Care.

Atlas of Anesthesia Volume V: Subspecialty Care.