Azoospermia/surgery* ; Humans ; Male ; Vas Deferens ; Vasectomy

OBJECTIVETo investigate the diagnosis and treatment of epididymal obstructive azoospermia (OA) by microsurgery.

METHODSWe performed surgical scrotal exploration for 57 cases of OA whose obstruction was suspected to be in the epididymis. Those confirmed to be epididymal OA cases and with motile sperm in the epididymis underwent longitudinal-2-suture intussusceptive vasoepididymostomy (LIVES). And for those with sperm in the epididymal head only or with bilateral obstruction or absence of the vas deferens in the distal epididymis, the sperm were collected and subjected to cryopreservation for intracytoplasmic sperm injection (ICSI). After surgery, the patients were followed up for observation of the semen parameters and the rate of pregnancy.

RESULTSOf the total number of patients, 53 (92.9%) were diagnosed with epididymal OA by scrotal exploration, 47 (82.5%) underwent microsurgery, and the other 10 (17.5%) received sperm cryopreservation. At 1 to 18 months after surgery, motile sperm were found in the ejaculate in 46.8% of the cases (22/47), natural pregnancy in 10.6% (5/47), and ICSI pregnancy in 18.5% (6/32).

CONCLUSIONWith the development of microsurgery, non-invasive means should be the first choice for the diagnosis of OA. And surgical exploration can be employed to determine the location of obstruction and the option for treatment.

Adult ; Azoospermia ; diagnosis ; surgery ; Epididymis ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Vas Deferens ; surgery

OBJECTIVETo investigate the clinical characteristics, diagnosis, misdiagnosis and treatment of pelvic vas deferens abscess.

METHODSThe clinical data of one case of pelvic vas deferens abscess were reported and the relevant literature was reviewed.

RESULTSThe patient underwent incision and drainage of pelvic vas deferens abscess. After the catheter was removed, he could urinate easily. With a follow-up of one year, he was found free of dysuria and recurrence.

CONCLUSIONPelvic vas deferens abscess tends to be misdiagnosed when enwrapped. Surgical procedures are the most effective treatment for this disease.

Abscess ; diagnosis ; surgery ; Aged ; Genital Diseases, Male ; diagnosis ; surgery ; Humans ; Male ; Pelvis ; Treatment Outcome ; Vas Deferens

PURPOSE: The proper functioning of all smooth muscle structures depends on the ability of normal blood to deliver oxygen and nutrients to the muscles. In addition, hypoxia has been shown to inhibit the contractile response to various forms of stimulation. The contractile response of the vas deferens can be divided into two phases: an initial rapid increase in tension(phasic contraction) and prolonged period of sustained tension(tonic contraction). The aim of this study was to determine the effect of hypoxia on the ability of the vas deferens to sustain tension . MATERIALS AND METHODS: The isolated strips of rat vas deferens were studied for Isometric tension measurement under normoxia and hypoxia in the organ chamber. Effects of phenylephrine(Phe) and acetylcholine(Ach) on the rat vas deferens tissue were monitored under normoxia and hypoxia. RESULTS: The results of these studies can be summerized as follows; (1) hypoxia induced time dependent decrease in both phasic and tonic contraction in response to electrical field stimulation(4 and 32Hz). The rate of inhibition of the tonic contraction was significantly and immediatly greater than that of the phasic contraction in both the prostatic and epididymal vas deferens, which was much prominent. (2) hypoxia(5min) increased the basal tension of prostatic vas deferens only to Phe(10(-3)M) and Ach(10(-3)M). But In the response of epididymal vas deferens to Phe(10(-3)M) and Ach(10(-3)M), rhythmic contractions disappeared. CONCLUSIONS: In conclusion, the contractile response of rat Vas deferens to electrical field stimulation under hypoxia were decreased and basal tension of prostatic vats deferens to Phe(10(-3)M) or Ach(10(-3)M) was increased This effect can interfere the sperm expulsion by changing normal contractability of the vas deferens.
Acetylcholine* ; Animals ; Anoxia* ; Muscle, Smooth ; Muscles ; Oxygen ; Phenylephrine* ; Rats* ; Spermatozoa ; Thoracic Surgery, Video-Assisted ; Vas Deferens*

OBJECTIVETo study the effect of Ar(+) laser on human vas deferens and to compare the effects of using different radiation levels with varying thickness of tissue and varying levels of injury.

METHODSAfter initial tests on animals, four human scrotums were opened and treated directly with Ar(+) laser radiation. Then 58 human individual scrotums were treated with radiation by the method of trans-skin puncture. The rate of sperm reduction and elimination was tested.

RESULTSIn 60 cases, the sperms were found to be eliminated completely after six months of radiation treatment. In 2 cases the sperms were found not to be eliminated completely due to the insufficient radiation.

CONCLUSIONAr(+) laser is one of the best forms of radiation for coagulation of vas deferens. It can be used to coagulate vas deferens without any complications or sequelae.

Adult ; Follow-Up Studies ; Humans ; Laser Coagulation ; Male ; Sterilization, Reproductive ; methods ; Vas Deferens ; surgery

Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.
Adult ; Cautery ; Humans ; Ligation ; Male ; Nepal ; Oligospermia ; Sperm Count ; Vas Deferens ; surgery ; Vasectomy ; methods

To date, there is little information about the demography of vasectomy reversal (VR) patients or the factors currently influencing VR effectiveness in China, especially after the universal two-child policy was released in 2015. In this research, demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China. Meanwhile, a telephone survey of the patients was conducted to collect follow-up information. Eventually, 448 VR cases from the past 13 years were included. The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate. Appropriately statistical methods were used, and all of the protocols were approved by the Ethics Committees of the institutes in this research. The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented. Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate. A follow-up survey showed that the general postoperative pregnancy rate was 27.2%. For female partners over the age of 35 years, the postoperative pregnancy rate showed a more severe decline, but only 35.5% of them had been given a fertility examination before their husbands' VR surgery. Our work revealed that more patients in China have been demanding VR in recent years. High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR. Clinical andrologists should perform a preoperative fertility evaluation of the patients' female partners.
Male ; Pregnancy ; Humans ; Female ; Adult ; Vasovasostomy ; Retrospective Studies ; Vas Deferens/surgery* ; Vasectomy ; China/epidemiology*

Adult ; Azoospermia/etiology* ; Choristoma/surgery* ; Humans ; Male ; Microdissection ; Sperm Retrieval ; Testicular Diseases/surgery* ; Testis/surgery* ; Vas Deferens/abnormalities*

Patients with congenital unilateral absence of the vas deferens (CUAVD) manifest diverse symptoms from normospermia to azoospermia. Treatment for CUAVD patients with obstructive azoospermia (OA) is complicated, and there is a lack of relevant reports. In this study, we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA. From December 2015 to December 2020, 33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital (Shanghai, China). Patient information, ultrasound findings, semen analysis, hormone profiles, and treatment information were collected, and the clinical outcomes were evaluated. Of 33 patients, 29 patients were retrospectively analyzed. Vasoepididymostomy (VE) or cross VE was performed in 12 patients, the patency rate was 41.7% (5/12), and natural pregnancy was achieved in one of the patients. The other 17 patients underwent testicular sperm extraction as the distal vas deferens (contralateral side) was obstructed. These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA, even with a relatively low rate of patency and natural pregnancy.
Pregnancy ; Female ; Humans ; Male ; Vas Deferens/abnormalities* ; Azoospermia/surgery* ; Epididymis/surgery* ; Retrospective Studies ; Tertiary Care Centers ; China ; Semen

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.
Humans ; Male ; Adult ; Retrospective Studies ; Body Mass Index ; Epididymis/surgery* ; Vas Deferens/surgery* ; Treatment Outcome ; Sperm Motility ; Microsurgery ; Surgeons ; Vasovasostomy