PURPOSE: Microsurgical vasovasostomy is associated with high patency and pregnancy rates, but is difficult and requires significant effort and time to learn. Therefore, we assessed a simplified loupe-assisted vasovasostomy method using a Prolene stent. MATERIALS AND METHODS: The medical records of 82 patients who underwent loupe-assisted vasovasostomy with a Prolene stent by a single surgeon between January 2004 and December 2015 were reviewed. The association between the vasal obstructive interval (VOI) and the success rate was evaluated. RESULTS: The average age at the time of vasovasostomy was 39.8 years (range, 29~57 years). The mean VOI was 6.6 years (range, 1~19 years). The mean operation time was 87.0 minutes (range, 55.0~140.0 minutes). The overall patency and natural pregnancy rates were 90.2% and 45.1%, respectively. The success rate decreased as time after vasectomy increased (odds ratio, 0.869; 95% confidence interval, 0.760~0.993; p=0.039). The cases were divided into 2 groups according to the mean VOI: group A (>7 years) and group B (≤7 years), with 31 cases (37.8%) and 51 cases (62.2%), respectively. The patency and pregnancy rates of group A were 80.6% and 51.6%, respectively, while those of group B were 96.1% and 41.2%, respectively. CONCLUSIONS: Loupe-assisted vasovasostomy using a Prolene stent is a safe and effective method.
Humans ; Medical Records ; Methods ; Polypropylenes* ; Pregnancy ; Pregnancy Rate ; Stents* ; Vasectomy* ; Vasovasostomy*

In the past 5 to 10 years, very few fields in modern medicine have changed so dramatically as reproductive medicine, especially for the treatment of male infertility. Advances have been made in intracytoplasmic sperm injection (ICSI), refined microsurgical reconstructive techniques (vasovasostomy and vasoepididymostomy), and microsurgical techniques of surgical sperm retrieval from the epididymis and testis. All men with epididymal obstruction (obstructive azoospermia) now have the opportunity to father their own biological children. In this article, the authors reviewed the most updated microsurgical vasovasostomy, vasoepididymostomy techniques and surgical indications as well as the key factors for successful microsurgical treatment. They also predicted the future directions and discussed the advantages of microsurgical techniques, emphasized the significant roles of microsurgical training for urological doctors to treat male infertility.
Epididymis ; surgery ; Fertilization in Vitro ; Humans ; Male ; Microsurgery ; Oligospermia ; surgery ; Sperm Injections, Intracytoplasmic ; Vasovasostomy ; methods

We evaluated a biodegradable graft for reconstruction of rat vasa deferentia with long obstructed or missing segments. A total of 47 Sprague-Dawley rats underwent bilateral vasectomy and were divided into groups according to length of the vas deferens affected (0.5, 1, 1.5 cm). After 8 weeks, poly-(D,L-lactide) (PDLA) grafts were used to reconnect the vas deferens. Grafts and adjoining vasa deferentia were excised 8 and 12 weeks later and evaluated microscopically. At 8 weeks, microscopic changes included a robust inflammatory response around the grafts. All grafts were still intact but in the early stages of degradation. No microtubules, indicative of vas deferens recanalization, were identified. One specimen showed evidence of healing and neovascularization at the interface zone between the vas deferens and the graft. At 12 weeks, grafts were further degraded but still present. Microscopic evaluation showed decreased inflammation. Seven specimens showed neovascularization at the interface zone; two of these showed distinct epithelialized vas deferens microcanals at the graft edges. One specimen showed a microcanal spanning the entire 0.5-cm graft. A time period of 8 weeks is not ample enough for vas deferens regeneration in the setting of a biodegradable PDLA graft; however, early evidence of re-growth was seen at 12 weeks. A longer healing time should permit further biodegradation of the graft, as well as re-growth and possible eventual reconnection of the vas deferens, allowing passage of sperm. These findings suggest a potential role for biodegradable grafts in the reconstruction of vas deferens with long obstructed segments.
Absorbable Implants ; Animals ; Graft Survival ; Male ; Rats ; Rats, Sprague-Dawley ; Vas Deferens ; cytology ; surgery ; Vasectomy ; Vasovasostomy ; methods

INTRODUCTIONIn line with the effort to evaluate feasible surgical options for vasectomy reversal and to increase patients' willingness to undergo the procedure, this study reported on a technique for ambulatory mini-incision microsurgical vasovasostomy using a double-ringed clamp (i.e. Moon's clamp). This technique does not require the use of dilators, approximators and other accessory devices.

METHODSAmbulatory mini-incision microsurgical vasovasostomy was conducted on 263 patients who satisfied the surgical eligibility requirements for vasovasostomy and the safety criteria for local anaesthesia. The operation time, details on postoperative recovery and results of the postoperative semen analysis were recorded and retrospectively analysed.

RESULTSThe mean time used to isolate the bilateral vas deferens was 25.5 minutes. All patients were discharged on the day of surgery and all patients returned to their normal activities within 24-48 hours after surgery. No haematoma or infection occurred except in one patient. Postoperative semen analysis showed that the surgery was successful in 182 (96.8%) of the 188 patients who complied with the postoperative patient instructions.

CONCLUSIONAmbulatory mini-incision microsurgical vasectomy reversal using Moon's clamp and under local anaesthesia is a surgically feasible option that offers the advantages of a low-risk operation. It also achieves successful vasovasostomy without other accessory devices and allows patients to return to their daily activities quickly with minimal complications.

Adult ; Anesthesia, Local ; methods ; Equipment Design ; Feasibility Studies ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; methods ; Middle Aged ; Retrospective Studies ; Surgical Instruments ; Suture Techniques ; instrumentation ; Vasovasostomy ; methods

OBJECTIVETo investigate the clinical effect of microsurgical vasoepididymostomy and/or vasovasostomy in the treatment of obstructive azoospermia.

METHODSThis study included 76 patients with obstructive azoospermia, 53 treated by bilateral vasoepididymostomy (8 involving the epididymal head, 18 involving the epididymal body, 5 involving the epididymal tail, and 22 involving the epididymal head, body and tail), 14 by unilateral vasoepididymostomy, and the other 9 by unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis). We followed up the patients for 2 to 16 months for the patency rate, routine semen parameters, and pregnancy outcomes.

RESULTSThe success rate of bilateral vasoepididymostomy, unilateral vasoepididymostomy, and unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis) were 62.26% (33/53), 35.71% (5/14), and 77.78% (7/9), respectively. The average sperm concentrations in the three groups of patients were (27.9 +/- 5.74), (11.8 +/- 8.33), and (19.9 +/- 7.53) x 10(6)/ml, the average total sperm counts were (65.6 +/- 13.71), (28.0 +/- 15.86), and (69.2 +/- 28.59) x 10(6), and the mean rates of progressively motile sperm were (22.3 +/- 3.18), (11.0 +/- 9.77), and (15.8 +/- 5.05)%, respectively. The success rates of bilateral vasoepididymostomy that involved the epididymal head, body, tail, and all the three parts were 62.5, 72.22, 60, and 54.55%, respectively. Natural pregnancy was achieved in 8 (10.53%) of the total number of cases.

CONCLUSIONMicrosurgery is effective for the treatment obstructive azoospermia. Unilateral vasoepididymostomy + unilateral vasovasostomy is superior to the other procedures, followed by bilateral vasoepididymostomy. Bilateral vasoepididymostomy involving the epididymal body may achieve a slightly better effect than that involving the other epididymal parts.

Adult ; Anastomosis, Surgical ; methods ; Azoospermia ; etiology ; surgery ; Epididymis ; surgery ; Female ; Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; Pregnancy ; Pregnancy Rate ; Sperm Count ; Treatment Outcome ; Vas Deferens ; surgery ; Vasovasostomy ; methods

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.
Adult ; Anastomosis, Surgical ; Azoospermia ; etiology ; pathology ; surgery ; Constriction, Pathologic ; complications ; pathology ; surgery ; Ejaculatory Ducts ; pathology ; surgery ; Epididymis ; pathology ; surgery ; Humans ; Male ; Microsurgery ; methods ; Retrospective Studies ; Sperm Motility ; Treatment Outcome ; Vasovasostomy ; methods

Seminal duct obstruction may result in obstructive azoospermia (OA) and severe oligoasthenoteratozoospermia (OAT) (<0.5 million/mL) (Nordhoff et al., 2015). Cases of partial OA and OAT can be treated effectively by microsurgical anastomosis (Goldstein and Kim, 2013) to obtain successful surgical reversal. However, microsurgical vasovasostomy (VV) (Dickey et al., 2015) and vasoepididymostomy (VE) (Peng et al., 2017) are not suitable for patients with atypical OA and poor epididymis conditions or unpredictable obstruction of the distal vas deferens. For those patients, cross anastomosis may be applied instead of routine VE or VV. A single-center, retrospective, comparison study was conducted, which assessed the usefulness of the cross VV (CVV) in the scrotum for indication and efficacy. A total of 77 cases with OA or OAT were included, and 20 cases implemented cross anastomosis, including unilateral CVV (UCVV) in 4 cases, unilateral VE plus CVV (UVE+CVV) in 11 cases, and unilateral VV-based CVV (UVV+CVV) in 5 cases. The other 57 cases received no cross-matching anastomosis. The patency and natural pregnancy rates in one year were 75.0% and 50.0%, respectively, in the UCVV group; 54.5% and 27.3%, respectively, in the UVE+CVV group; and 60.0% and 40.0%, respectively, in the UVV+CVV group. The CVV in the scrotum in the selected patients with OA and severe OAT could yield good results. We regard the CVV in the scrotum as an efficacious operation with a lower risk of injury in cases of atypical OA.
Adult ; Anastomosis, Surgical ; Azoospermia/surgery* ; Epididymis/pathology* ; Female ; Humans ; Infertility/surgery* ; Male ; Oligospermia/surgery* ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Scrotum/surgery* ; Treatment Outcome ; Vas Deferens ; Vasovasostomy/methods* ; Young Adult