Microsurgical Vasoepididymostomy Research Articles

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

This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates. Data from patients with EOA who underwent two-suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random-effects model, and weighted mean differences were reported. A total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63-72%), with a patency time of approximately 4.63 months (95% CI: 4.15-5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31-46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double-armed and single-armed LIVE techniques. The single-armed LIVE is a potential alternative surgical option when high quality double-needle sutures are not easily accessible.

Impact of Epididymal Sperm Aspiration on Microsurgical Vasoepididymostomy Outcomes in Patients with Obstructive Azoospermia-Report of 21 Cases Attached

ABSTRACT Background: To explore the impact of epididymal sperm aspiration on microsurgical vasoepididymostomy (MVE) outcomes in patients with obstructive azoospermia (OA). Methods: A retrospective analysis was conducted on 21 patients with OA who underwent epididymal sperm aspiration and received treatment at the department of andrology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from September 2016 to March 2023. Under microscopic scrutiny, the structure of the epididymis and any injuries to its ducts were observed and compared during MVE. Results: Microscopic analysis of 21 patients revealed notable changes in the appearance of the epididymis, showcasing substantial scar contracture and evident adhesion between the epididymal fascia and tunica vaginalis within the sheath, posing challenges in their separation. Among them, 12 patients exhibited fractured, shrunk, fibrotic, and semen-devoid epididymal ducts. Consequently, MVE could not be completed in 15 patients because of these factors, and only six patients underwent MVE. Among the patients who successfully underwent MVE, three patients had sperm in the follow-up examination 3 months after surgery, accounting for 50%. Conclusion: Epididymal sperm aspiration can damage the normal structure of the epididymis and epididymal duct, often leading to surgical termination during operation and a decrease in the long-term patency rate following surgery. Therefore, patients with OA are recommended to undergo MVE as the initial procedure. In case the surgery prove unsuccessful, epididymal or testicular sperm aspiration can be performed for intracytoplasmic sperm injection (ICSI) assisted reproduction. Additionally, patients with OA are advised to avoid diagnostic epididymal sperm aspiration.

Outcomes of microsurgical vasoepididymostomy using intussusception technique: a systematic review and meta‑analysis

A systematic review and meta-analysis of microsurgical vasoepididymostomy (MVE) for treating epididymal obstructive azoospermia (EOA) with different intussusception techniques. We conducted a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, retained literature related to obstructive azoospermia or male infertility and vasoepididymostomy, proactively reviewed other relevant literature, supplemented valuable references, and excluded studies that did not use intussusception and where valuable statistical data were difficult to obtain. Event rate and risk ratio (RR) were estimated. Patency rates were investigated. The influence of motile sperms found in the epididymal fluid, anastomotic sides and sites on patency was evaluated. 273 articles were comprised in this analysis, and 25 observational studies were eventually included, with a total patient sample of 1400. The overall mean patency rate was 69.3% (95% confidence interval [CI] 64.6–73.6%; I2 = 63.735%). We conducted a meta-analysis of the factors affecting patency after microsurgical IVE, finding that the presence of motile sperms in epididymal fluid (RR = 1.52; 95% CI 1.18–1.97%; P = 0.001), anastomosing bilaterally (RR = 1.32; 95% CI 1.15–1.50%; P < 0.0001) and distally (RR = 1.42; 95% CI 1.09–1.85%; P = 0.009) lead to higher patency rates. IVE is an effective treatment for EOA. The presence of motile sperms found in the epididymal fluid, anastomosing bilaterally and distally are significantly correlated with higher patency rates.

The effect of BMI and age on the outcomes of microsurgical vasoepididymostomy: a retrospective analysis of 181 patients operated by a single surgeon.

To design a treatment plan for patients with epididymal obstruction, we explored the potential impact of factors such as body mass index (BMI) and age on the surgical outcomes of vasoepididymostomy (VE). In this retrospective study, 181 patients diagnosed with obstructive azoospermia (OA) due to epididymal obstruction between September 2014 and September 2017 were reviewed. All patients underwent single-armed microsurgical intussusception VEs with longitudinal two-suture placement performed by a single surgeon (KH) in a single hospital (Peking University Third Hospital, Beijing, China). Six factors that could possibly influence the patency rates were analyzed, including BMI, age, mode of anastomosis, site of anastomosis, and sperm motility and quantity in the intraoperative epididymal fluid. Single-factor outcome analysis was performed via Chi-square test and multivariable analysis was performed using logistic regression. A total of 159 (87.8%, 159/181) patients were followed up. The follow-up time (mean ± standard deviation [s.d.]) was 27.7 ± 9.3 months, ranging from 12 months to 48 months. The overall patency rate was 73.0% (116/159). The multivariable analysis revealed that BMI and age significantly influenced the patency rate (P = 0.008 and 0.028, respectively). Younger age (≤28 years; odds ratio [OR] = 3.531, 95% confidence interval [95% CI]: 1.397-8.924) and lower BMI score (<26.0 kg m-2; OR = 2.352, 95% CI: 1.095-5.054) appeared to be associated with a higher patency rate. BMI and age were independent factors affecting the outcomes of microsurgical VEs depending on surgical expertise and the use of advanced technology.

Current progress on the curative effects of vasoepididymostomy for patients with obstructive azoospermia: An updated systematic review and meta-analysis of human studies.

Obstructive azoospermia (OA) is an important cause of male infertility, and epididymal OA (EOA) is a common disease. Microsurgical reconstruction is a common technique used in the treatment of EOA. In the present study, we analyzed the effectiveness of microsurgical vasoepididymostomy (MVE) at different levels and compared the differences among several MVE techniques. A literature search was conducted in the PubMed, Web of Science, and Embase databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies were published in English until May 14, 2021. The R 4.1.2 software was utilized to evaluate the event rate, risk ratio (RR), and 95% confidence interval (CI). A total of 51 studies involving 2853 patients with OA were included in our meta-analysis. The overall mean patency rate of patients who underwent MVE was 67.20% (95% [CI]:63.30%-71.10%), and the overall mean natural pregnancy rate of their partners was 40.05% (95% [CI]: 35.30%-45.60%). The pooled results showed that the patency rate of bilateral MVE was higher than that of unilateral MVE (RR=1.42; 95% [CI]:1.25-1.61; p<0.00). A comparison of the anastomotic site of MVE showed that the caudal/corpus area was favorable for the patency rate (RR=1.17; 95% [CI]:1.04 - 1.32; p<0.00). The caudal area was also advantageous for the patency rate (RR=1.20; 95% CI:1.03 - 1.41; p<0.04). Compared with typical MVE (65.20%, 95% [CI]:61.40%-69.10%), deferential vessel-sparing MVE with a higher overall mean patency rate (83.60%, 95% [CI]:75.40%-91.70%). The meta-analyses indicated that MVE is a high- and cost-effective therapeutic method for patients with EOA, and deferential vessel-sparing MVE could be mainstream in the near future.

Clinical outcome of microsurgical vasoepididymostomy versus epididymal or testicular sperm retrieval combined with intracytoplasmic sperm injection in obstructive azoospermia males.

This purpose of the retrospective study was to compare the clinical outcome of microsurgical vasoepididymostomy (MVE) and sperm retrieval combined with intracytoplasmic sperm injection (ICSI) in the treatment of males with obstructive azoospermia. From February 2018 to December 2019, a total of 69 males with obstructive azoospermia underwent MVE while 351 males with obstructive azoospermia in their first ICSI cycles were enrolled. Patients in the MVE group achieved higher pregnancy rate and births delivered rate than those in ICSI group (pregnancy rate, 44.6% vs. 27.6% for MVE and ICSI, respectively; delivery rate, 38.5% versus 25.8% for MVE and ICSI, respectively). Besides, lower female age (<35 vs. ≥35 years old, OR 1.15, 95% CI=1.08-1.21), higher sperm concentration and forward motility after MVE((sperm concentration, OR (95% CI)=1.12 (1.08-1.23), sperm forward motility, OR (95% CI)=1.10 (1.06-1.20)) were associated with higher probability of pregnancy. Based on these data, it has been found that MVE is the prior option for males with obstructive azoospermia suitable for the surgery, other than direct subjected to ICSI. More high quality studies are needed in the future due to the non-randomized design and the relative small size of this study.

A Modified Vessel-sparing Microsurgical Vasoepididymostomy.

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, preserving the vasal vessels during MVE might better simulate the normal physiological structure and be meaningful for patients who have undergone varicocelectomy. Nevertheless, preserving the vasal vessels might elevate the risk of increasing the tension of anastomosis, affecting the patency rate and leading to delayed postoperative bleeding. Therefore, we developed a novel vessel-sparing MVE to make it safer. Here is a summary of the improvements to the procedure. 1) The retrograde dissociation of the vasal vessels on the proximal testicular side was adopted as the main method, and the anterograde dissociation of the vasal vessels on the distal testicular side was adopted as a supplement to dissociate the vasal vessels to be preserved. This improvement ensures the blood supply to the vas deferens that will be used for anastomosis and also provides longer vasal vessels, which reduces the tension of anastomosis. 2) By fixing the vas deferens to be anastomosed and the broken end of the vas deferens, the free vasal vessels get fixed, which resolves the problem of transmission of vas tension to the vasal vessels and reduces the risk of vasal vessel hemorrhage. 3) Dissociation of the vas deferens after opening the tunica vaginalis increases the mobilization of the vas deferens, which also makes the new procedure easier to complete. The evaluation of the outcomes of this new procedure showed that no significant postoperative complications occurred in the patients, and the patency rate was no different from that of the conventional procedure. Therefore, this new, improved procedure can be considered safe, with satisfactory postoperative results.

Successful microsurgical vasoepididymostomy for a case of cryptozoospermia

Successful microsurgical vasoepididymostomy for a case of cryptozoospermia

Vasal vessel‐sparing microsurgical single‐armed vasoepididymostomy to epididymal obstructive azoospermia: A retrospective control study

This study aimed to evaluate the efficacy and safety of vasal vessel-sparing modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE) to epididymal obstructive azoospermia patients. Forty consecutive epididymal obstructive azoospermia cases, who underwent microsurgical vasoepididymostomy in Shanghai General Hospital from January 2019 to October 2019, were included in this study. Twenty cases underwent SA-LIVE (group A), and 20 cases underwent vasal vessel-sparing SA-LIVE (group B). Until March 2021, the mean follow-up period was 16.9±4.1 (12-23) months. The overall patency rate was 82.5%, and 80% and 85% for group A and group B respectively. The mean time to achieve patency was 4.11±2.74months. The overall natural pregnancy rate was 51.5%(17/33) at the mean follow-up of 16.9months. The natural pregnancy rate was 50.0% for group A and 52.9% for group B (p>.05). At the time of 6months post-operation, the patency rate was 70% for group A and 80% for group B (p=.465); the natural pregnancy rate was 0% for group A and 31.3% for group B (p=.022). Vasal vessel-sparing SA-LIVE is safe and effective to achieve favourable patency and pregnancy rates. Preserving vasal vessel would improve natural pregnancy rate at a very early stage.

Rat model and validation of a modified single-armed suture technique for microsurgical vasoepididymostomy: Guo's SA-LIVE.

Double-armed suture longitudinal intussusception vasoepididymostomy (DA-LIVE) has been widely adopted owing to its simplicity and high success rate; however, specialized double-armed microsutures are required. To provide a novel single-armed suture longitudinal intussusception vasoepididymostomy (SA-LIVE) technique using only two single-armed sutures, named Guo's SA-LIVE. Four weeks after vasectomy in male adult Wistar rats, vasoepididymostomies were performed using DA-LIVE, SA-LIVE, or Guo's SA-LIVE. After 12weeks, functional patency was functionally assessed by evaluating for motile spermatozoa distal to the anastomosis. If no motile spermatozoa were visible, the mechanical patency of the anastomosis was tested by the ability of methylene blue to pass through the surgical anastomosis. The key procedure in Guo's SA-LIVE was cutting each needle with over 1cm attaching suture and making a flat overhand bend knot to tie the needle to the other end of the suture, after the needles were passed through the epididymal tubule and then the vasal lumen in an inside-out fashion, and then, the needles were passed through the vasal lumen in an inside-out fashion. The proportions of functional patency were 50.0% (3/6), 33.3% (2/6), and 50% (3/6) for the DA-LIVE, SA-LIVE, and Guo's SA-LIVE groups, respectively (P=.799). The proportions of mechanical plus functional patency for the three methods were 83.3% (5/6), 66.7% (4/6), and 83.3% (5/6), respectively (P=.725). The mean anastomosis times for the three LIVE techniques and the proportions of complications were similar (P=.150 and .758, respectively). Guo's single-armed suture technique is a potentially effective alternative to perform vasoepididymostomy when specialized double-armed microsutures are not available based on the current animal experiment.

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

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.

MP44-12 SHALL WE RE-EVALUATE THE RELATIONSHIP BETWEEN BMI, AGE AND OUTCOMES OF MICROSURGICAL VASOEPIDIDYMOSTOMY: A MULTIPLE-FACTOR ANALYSIS OF 181 PATIENTS UNDERWENT MICROSURGICAL VASOEPIDIDYMOSTOMY BY A SINGLE SURGEON

You have accessJournal of UrologyInfertility: Therapy I (MP44)1 Apr 2020MP44-12 SHALL WE RE-EVALUATE THE RELATIONSHIP BETWEEN BMI, AGE AND OUTCOMES OF MICROSURGICAL VASOEPIDIDYMOSTOMY: A MULTIPLE-FACTOR ANALYSIS OF 181 PATIENTS UNDERWENT MICROSURGICAL VASOEPIDIDYMOSTOMY BY A SINGLE SURGEON Kai Hong*, Shouyang Wang, Haitao Zhang, Hui Jiang, and Lulin Ma Kai Hong*Kai Hong* More articles by this author , Shouyang WangShouyang Wang More articles by this author , Haitao ZhangHaitao Zhang More articles by this author , Hui JiangHui Jiang More articles by this author , and Lulin MaLulin Ma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000899.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Single-armed two-suture vasoepididymostomy (VE) technique has been widely used, which proved to be one of effective and safe surgical options for the treatment of obstructive azoospermia (OA) caused by primary epididymal obstruction. Factors which may affect outcomes of VE has been reported. However, some of those factors become not much important to the outcomes of VE with the improvement of surgical technic and the accumulating experience of surgeons. We focused on the new-interested factors of BMI and age affecting the surgical outcome of VE and evaluated their clinical value in improving the patency rate. At the same time, other factors what might affect the outcomes were re-evaluated. METHODS: 181 azoospermia patients cause by primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon (KH) at Peking University Third Hospital, Beijing, China from September 2014 to September 2017 were followed up consecutively. Body mass index (BMI), age, together with other five factors such as methods of bilateral or unilateral anastomosis, anastomosis sites, the motility and quantity of sperms found in epididymal fluid intraoperatively, what were possibly related to the patency rates were analyzed. RESULTS: Among 181 patients, 159 (87%, 159/181) patients were followed through either telephone calls or interview. 22 patients were lost to follow-up. The mean follow-up time was 27 (12 ∼ 48) months. Patency was defined by finding sperms in semen analyses or natural impregnation during the follow-up. The patency rate was 73.0% (116/159). Then, with the logistic regression multifactor analysis, we confirmed that factors of BMI and age were related to a higher patency rate (P = 0.008 and 0.028, respectively). A younger age and a lower BMI score appeared to be associated with a higher patency rate (OR = 3.531 and 2.352, 95% CI = 1.397, 8.924 and 1.095, 5.054, respectively). CONCLUSIONS: BMI and age were confirmed to be independent influencing factors for the outcomes of microsurgical VEs on humans when the technology matured and the surgeons were experienced. We suggest patients take microsurgical VE before 28 years old and control their BMI under 26 to achieve better surgical outcomes. Other factors analyzed in this study appeared no significant relationship with patency. Source of Funding: 1. Beijing Municipal Natural Science Foundation 2. National Key Research and Development Program of China © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e661-e661 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kai Hong* More articles by this author Shouyang Wang More articles by this author Haitao Zhang More articles by this author Hui Jiang More articles by this author Lulin Ma More articles by this author Expand All Advertisement PDF downloadLoading ...

Analysis of the related factors affecting the recurrence of microvasectomy after epididymis anastomosis

Objective To explore the related factors of reconnection after microvasectomy and epididymis anastomosis. Methods From January 2014 to December 2017, 120 cases of microsurgical vasoepididymostomy treated in our hospital from January 2014 to December 2017 were randomly selected.During the study period, the operative methods, age, course of disease, anti-sperm antibody and the relationship between them and the patient's reproduction were investigated in detail. Logistic regression equation was used to calculate and analyzed the related factors of recanalization after microsurgical vasoepididymostomy. Results We found that 102 cases were recanalized after microsurgical vasoepididymostomy, the recanalization rate was 85.0%, 18 cases were not recanalized, and the recanalization rate was 15.0%. Comparison of two sets of general data found, there were significant differences between the two groups in age, course of disease, number of anastomosis, epididymal fluid analysis and anastomosis site(P<0.05). The differences were calculated by logistic regression equation. Age, course of disease, number of anastomosis, analysis of epididymal fluid and site of anastomosis were found to be the influencing factors of vasectomy under microscope. Conclusions There are many related factors that cause the recanalization after microsurgical vasoepididymostomy.Therefore, doctors can further improve the recanalization rate by reducing the intraoperative factors. Key words: Vasovasostomy; Recovery of Function

Seminal plasma neutral alpha-glucosidase activity as an early predictor of patency and natural pregnancy after microsurgical vasoepididymostomy.

Microsurgical vasoepididymostomy (MVE) is recommended as a first-line option for treatment of epididymal obstructive azoospermia (EOA). However, early indicators for predicting patency and natural pregnancy are unclear. Our aim was to explore the early predictive value of seminal plasma neutral alpha-glucosidase (NAG) activity for patency and natural pregnancy after MVE. Eighty-four patients with EOA who underwent MVE were enrolled in this study. The post-operative patency and natural pregnancy rates were 60.71% and 33.33% respectively. The presence of motile epididymal spermatozoa at the anastomosis site and NAG activity measured at the first month after MVE were early and independent predictors of patency and natural pregnancy. The areas under the receiver operating characteristic curves (AUCs) of NAG activity for prediction of patency and natural pregnancy were 0.78 (95% confidence interval [CI]: 0.68-0.88) and 0.82 (95% CI: 0.73-0.92). The best cut-off values of NAG activity for predicting patency and pregnancy were 15.9 and 17.0m IU/ejaculate respectively. In conclusion， NAG activity measured at the first month after MVE is an early and independent predictor of patency and natural pregnancy.

Retrospective analysis of factors affecting patency rates and causes of failure in use of single-armed two-suture microsurgical vasoepididymostomy

Objectives: To analyze the factors affecting the patency rate of microsurgical single-stitch longitudinal intussusception vasoepididymostomy and to explore the possible causes of failure. Methods: The clinical data of 87 patients with epididymal obstructive azoospermia who underwent microsurgical vasoepididymostomy from January 2015 to February 2018 in the First Affiliated Hospital of Fujian Medical University were analyzed retrospectively. We observed the patency rate postoperatively and evaluated several factors that possibly related to the patency rates. Preoperative examinations included peripheral blood chromosomes, Y chromosome microdeletions, sex hormones, seminal plasma, etc. After admission, microsurgical single-stitch longitudinal intussusception vasoepididymostomy was performed. During the follow-up, the semen was evaluated to assess the patency rate and the time to patency. Results: The patient's age ranged from 21 to 42 years and the mean age was(25±3) years. Infertility lasted for 1-8 years and the mean infertility time was(2.2±1.1) years. The longitudinal intussusception vasoepididymostomy was successfully completed in 80 patients , 5 cases gave up the anastomosis surgery because of multiple segment obstruction of the vas deferens, complete obstruction of the epididymis or testicular obstruction. Two cases underwent crossed vasovasostomy( sperm was present in the ejaculate in 1 case postoperatively). Of all the patients, 72 were successfully followed up. The follow-up time was 3-29 months, with an average of (12.0±1.7)months. Excluding 3 cases of follow-up time less than 12 months who still had no sperm in the ejaculate, 69 patients' data were in cluded in the final statistics, of which 50 cases with return of sperm in the ejaculate, the overall patency rate was 72.5%(50/69), concentration of sperm was 0.1-137.2 million/ml, and the mean concentration was(29±21) million/ml; with the progressive motile sperm rate ranging from 0-57.9%, the mean rate was(29.9±21.1)%. The patency rates of motile sperm and immobile sperm found in epididymal fluid during surgery were 82.2%(37/45) and 54.2%(13/24), respectively. The patency rate of bilateral and unilateral anastomoses was 77.6%(45/58) and 45.5%(5/11), respectively; the patency rate of caput anastomosis was 47.8%(11/23), and 84.8%(39/46) for corpus or caudal anastomosis. 17 patients achieved natural pregnancy postoperatively, the rate was 34.0%(17/50). Conclusions: The therapeutic effect of microsurgical single-stitch longitudinal intussusception vasoepididymostomy is satisfactory. The motile spermatozoa in epididymal fluid, bilateral surgery and corpus or caudal anastomosis can improve the patency rate postoperatively.

The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta-analysis.

This study comprises a systematic review and meta.analysis of microsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia. A comprehensive literature search was performed using Medline, Embase, and the Cochrane library that included all studies related to microsurgical vasoepididymostomy. Keywords included “vasoepididymostomy” “epididymovasostomy” “epididymal obstruction” and “epididymis obstruction” Event rate and risk ratio (RR) were estimated. Patency rate and pregnancy rate were investigated. The analysis comprised 1422 articles, including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017. The overall mean patency rate was 64.1% (95% confidence interval [CI]: 58.5%.69.3%; I2=83.0%), and the overall mean pregnancy rate was 31.1% (95% CI: 26.9%.35.7%; I2=73.0%). We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38% (95% CI: 1.21%–1.57%; P < 0.00001). A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR = 1.17%; 95% CI: 1.01%–1.35%; P = 0.04). Patients with motile sperm in epididymal fluid exhibited an RR of 1.53% (95% CI: 1.11%–2.13%; P = 0.01) with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.

Multifactor analysis of postoperative patency of microsurgical vasoepididymostomy

Objective To analyze the factors which may affect postoperative patency of microsurgical vasoepididymostomy (VE). Methods Ninety-four patients underwent VEs from September 2014 to June 2016 in the Department of Urology, Peking University Third Hospital, with average age of (30.7±4.8)years, and body mass index(BMI) of (25.1±3.0) kg/m2. Semen analyses were performed 1 month, 3 months and 5 to 6 months after the operation. The following semen analyses were performed every 3-6 months thereafter. Patency was defined by finding sperms in twice or more analyses during the follow-up until August 2017. Patients were followed up by face-to-face or telephone interview. Seven factors (age, BMI, bilateral or unilateral anastomosis, anastomosis sites, the adjustment of anastomosis sites, motility and quantity of sperms found in epididymal fluid) were analyzed by Chi-square analysis and multifactor logistic regression analysis. Results Eighty-two patients were followed up (87.2%, 82/94) while 12 patients were lost of follow-up. The mean follow-up time was 19 months. Sperms were found in the ejaculate in 59 patients postoperatively. The overall patency rate was 72.0% (59/82), and natural paternity rate was 32.8% (19/58). Patients ≤28 years old and those >28 years old had patency rates of 89.3% (25/28) and 63.0% (34/54, P=0.012), respectively. Patients with BMI<26.0 kg/m2 and BMI≥26.0 kg/m2 had patency rates of 80.4% (41/51) and 58.1% (18/31, P=0.029), respectively. Patency rate of bilateral surgery was 72.1% (44/61) and of unilateral surgery was 71.4% (44/62, P=0.727). Patency rate of caput anastomosis achieved 75.0% (15/20) and of corpus/caudal anastomosis was 71.0% (44/62, P=0.727). Patency rates of patients with and without adjustment of anastomosis sites were 77.8% (7/9) and 71.2% (52/73, P=0.680), respectively. Patency rates of a lot, a few, motile and seldom-motile sperms in epididymal fluid were 74.3% (55/74) vs. 50.0% (4/8, P=0.146) and 70.0% (28/40) vs. 73.8% (31/42, P=0.701), respectively. Multifactor logistic regression analysis showed that age was well associated with patency rate (OR=4.705, 95%CI 1.181-18.742, P=0.028). Conclusions Age ≤28 years is an independent factor leading to higher patency rates. Patients with lower BMIs and younger could have higher patency rates. Factors of anastomosis sides, anastomosis sites, the adjustment of anastomosis sites, motility and quantity of sperms found in epididymal fluid showed no statistical difference in patency rates. Key words: Infertility, male; Obstructive azoospermia; Microsurgery; Vasoepididymostomy

A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy.

Microsurgical longitudinal intussusception vasoepididymostomy (LIVE) has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine (85.5%, 59/69) men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis (>10 000 sperm/ml) in 83.1% (49/59) of men. The natural pregnancy rate was 40.7% (24/59) by the end of the study, with 87.5% (21/24) of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.

AB023. Scrotal exploration and microsurgical vasoepididymostomy in azoospermic patients due to non-vasectomy, non-traumatic etiologies

BackgroundNon-iatrogenic, non-traumatic obstructive azoospermia (OA) includes causes like congenital bilateral absence of vas deferens (CBAVD), blockage at rete testis, or obstruction distal to internal inguinal rings. The blockage could be potentially identified at scrotal exploration and corrected with microsurgical vasoepididymostomy (VE). The purpose of this study is to analyze patients with non-iatrogenic, non-traumatic OA who underwent scrotal exploration with or without VE anastomosis in our institution.MethodsRetrospective chart review was done for patients treated from 2000 to 2015. Normal spermatogenesis confirmed by testis needle biopsy in all patients with OA. The operation method for VE anastomosis was two-stitch longitudinal intussusception technique. Patients who had prior vasectomy or history of vas deferens trauma/injury were excluded. The age, hormone profile, semen parameters, level of obstruction, semen quality at proximal epididymal cut-end and patency rates were analyzed.ResultsTotally 96 patients with mean age 35.4±5.6 y/o were collected. The obstruction level was at: bilateral rete testis blockage (n=17), bilateral epididymis (n=49), bilateral intra-abdominal blockage (n=7), CBAVD variants (n=3). There were 68 patients received VE anastomosis. The patency rates 6 months after operation for patients with bilateral epididymal blockage were 88%. They were 90.9% for blockage at both epididymal tails, 88.9% at epididymal body, and 83.3% at epididymal head. Motile sperm at proximal cut-end had patency rates at 80.6%, while they were 50% in cases showing only immotile sperm. The mean patency rates were 79.5% for all cases 6 months after operation. Twenty-eight percent of patients failed to proceed the correction procedure, including 25% with high or low blockage, and 3.1% with CBAVD variants. Patients with CBAVD variants showed lower semen pH (6.67±0.1, P=0.001).ConclusionsFor patients with non-iatrogenic non-traumatic OA receiving scrotal exploration, 28.1% are not eligible for correction. The mean patency rates for all patients 6 months after micro-anastomosis were 79.5%. They were 90.9% and 88% for cases with obstruction at bilateral epididymal tails and body respectively. Motile sperm in proximal end predicts higher patency rates.

448 - Pregnancy and live birth rates of microsurgical vasoepididymostomy for azoospermic patients with epididymal obstruction in the era of intracytoplasmic sperm injection and possible factors affecting the outcomes

448 - Pregnancy and live birth rates of microsurgical vasoepididymostomy for azoospermic patients with epididymal obstruction in the era of intracytoplasmic sperm injection and possible factors affecting the outcomes