A new one-layer epididymovasostomy technique

One-layer macroscopic verus two-layer microscopic vasovasostomy: Our experience in two referral hospitals

OBJECTIVE

Vasovasostomy is the most common surgery to restore the fertility of vasectomized men. This study aimed to compare the outcomes of one-layer macroscopic VV (MOLVV) or two-layer microscopic VV (TLMVV).

METHODS

This study was performed on the medical records of 100 patients who underwent VV surgery in two tertiary hospitals from 2014 to 2017. All patient information, including demographic and sperm analysis, was collected. The chi-square test, independent t-test, and survival analysis using Kaplan-Meyer test and Cox regression were performed to analyze the data using SPSS software version 25, and the significance level was considered 0.05.

RESULTS

The fertility rate in patients of both groups was 15%. The findings showed a statistically significant difference between the mean percentage of normal sperm morphology according to the type of surgery (p = 0.045). There was no statistically significant difference between the mean sperm count, sperm motility percentage, and mean hospital costs according to the type of surgical procedure (p > 0.05). The incidence of spouse pregnancy in the TLMVV method after 15 and 24 months was 87.5% and 58.3%, respectively. In patients with unilateral anastomosis, the incidence of pregnancy at 13 and 15 months after surgery was 98.7% and 95.8%, respectively. The mean and median time of pregnancy in the spouses of patients with each surgical shower were 24 and 25 months. Other variables had no significant effect on spouse pregnancy.

CONCLUSION

Vasovasostomy with the one and two-layer methods had equal results. The number, movement, and normal morphology of sperm after surgery were low. Therefore, these people will need assisted reproductive techniques.

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

BACKGROUND

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.

MATERIALS AND METHODS

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).

RESULTS

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%).

CONCLUSIONS

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.

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.