Reoperation strategies for obstructive azoospermia with initial microsurgical anastomosis failure (21 cases)
10.3760/cma.j.cn101441-20201207-00665
- VernacularTitle:梗阻性无精子症再次精道显微重建术策略分析——附21例报道
- Author:
Jingpeng ZHAO
1
;
Peng LI
;
Huixing CHEN
;
Ruhui TIAN
;
Erlei ZHI
;
Yuhua HUANG
;
Chencheng YAO
;
Zheng LI
Author Information
1. 上海交通大学附属第一人民医院泌尿外科临床医学中心男科，上海交通大学泌尿外科研究所，男性健康评估中心，上海 200080
- Publication Type:Journal Article
- Keywords:
Obstructive azoospermia;
Reoperation;
Microsurgery;
Male infertility
- From:
Chinese Journal of Reproduction and Contraception
2022;42(4):394-398
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the effectiveness and safety of reoperation for obstructive azoospermia (OA) with initial microsurgical anastomosis failure.Methods:A retrospective case series was performed for OA patients who underwent reoperation after initial microsurgical anastomosis failure, in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Institute of Urology, Urologic Medical Center from March 2015 to June 2020. Totally, 21 patients were enrolled in the study, and the clinical data, patency and pregnancy outcomes were reviewed.Results:During the initial surgery, 8 cases underwent vasovasostomy and 8 cases underwent vasoepididymostomy, while the other 5 cases underwent crossover anastomosis; 19 cases underwent reoperation because of reproductive needs, and 2 for post-vasectomy chronic testicular pain. During the reoperation, anastomotic stricture was found in 14 cases, and sperm granuloma was found in 6 cases, while spermatogenic dysfunction was confirmed in 1 case. Unilateral or bilateral anastomosis was performed successfully in 19 cases. Testicular sperm extraction was performed for 1 case with non-obstructive azoospermia (NOA) and 1 case with severe adhesion respectively. Totally 19 cases was followed for 3 to 58 months [(30.21±18.43) months], and 2 cases were lost to follow-up. Chronic testicular pain was relieved completely in 1 of the 2 cases suffering from the post-vasectomy testicular pain. Overall, 11 cases achieved patency, and 4 cases concieved naturally. Furthermore, 3 cases underwent in vitro fertilization cycle (1 case with semen sperm, and the other 2 cases with frozen testicular sperm). There were no severe post-operational complications in all cases. Conclusion:Microsurgical reoperation, which allows a favorable patency rate and natural pregnancy rate, is a valid option for the treatment of OA with initial microsurgical anastomosis failure.
