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

Authors
  • Liu, Nachuan1
  • Li, Peng1
  • Zhi, Erlei1
  • Yao, Chencheng1
  • Yang, Chao1
  • Zhao, Liangyu1
  • Tian, Ruhui1
  • Chen, Huixing1
  • Huang, Yuhua1
  • Yu, Yuexin2
  • Li, Zheng1
  • 1 Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China , Shanghai (China)
  • 2 Anhui Medical University, Hefei, 230032, China , Hefei (China)
Type
Published Article
Journal
BMC Urology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Aug 12, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12894-020-00692-5
Source
Springer Nature
Keywords
License
Green

Abstract

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.

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