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Azoospermia
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Medhat Amer, Emad Fakhry, Botros Rizk
The decision to proceed with microsurgical reconstruction for vasectomy reversal is based upon past surgical history, prior fertility, and the female partner age and fecundity because sperm recovery in the ejaculate may take a year or more. According to the obstruction level, those men can undergo a vaso-vasostomy or a vaso-epididymostomy. Patency rate is almost 100% with vaso-vasostomy when sperm are found in the vas before anastomosis. While with vaso-epididymostomy, the patency rate is between 50% and 80%. Pregnancy rates after vaso-vasostomy can reach 63% without assisted reproduction, which would decrease to 43% after a vaso-epididymostomy. Predictors of microsurgical reconstruction outcomes include intraoperative vasal fluid quality and sperm granuloma presence, vasal obstructive interval, and surgeon experience [8,43].
Microsurgery Techniques in Andrology *
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Vasoepididymostomy with most conventional techniques has yielded miserable success rates, somewhere between 2 and 10%. The epididymal tubule is so tiny and so delicate that the gross techniques available would simply rarely succeed. It is not merely the introduction of the operative microscope which is important in this approach to vasoepididymostomy. Also, it is not recommended to make a longitudinal slit in the epididymis in the traditional fashion, as it would not allow for the identification of the specific tubule to which the vas lumen should be anastomosed (Figure 11). It is advisable to get proximal to the level of the epididymal occlusion but to conserve as much epididymal length as possible. It is beneficial to serially section the epididymis going from the caudal region proximally until one crosses that transition zone from finding no sperm in the epididymal fluid to finding the epididymal fluid loaded with sperm. If simply a longitudinal incision were made it would be very difficult to locate that transition point. The operation is extraordinarily delicate. Unlike microscopic vasovasostomy, vasoepididymostomy requires a great deal of experience and seasoning with all kinds of microsurgical techniques. If a vasectomy reversal fails, it can always be performed again with a more accurate technique. But if a vasoepididymostomy fails, the subsequent scarring around this delicate structure makes later operations extremely difficult.
Sperm recovery techniques Clinical aspects
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Herman tournaye, Patricio Donoso, Francisco Osorio
Often the diagnosis of azoospermia is made without centrifuging the semen. Centrifugation at 1800 x g for at least five minutes may reveal spermatozoa in the pellet, which may be used for ICSI (14). In 2007, a national survey conducted by Swanton et al. including all 70 IVF units in the U.K. revealed that 91% of these centers routinely performed extended sperm preparation (ESP). In the same communication, the Oxford Fertility Unit presented a series of 87 azoospermic men in which ESP identified sperm in 22% of the cases. This percentage rises to 30% excluding patients after attempted vasectomy reversal (15). In cases of NOA, it may therefore be worthwhile to perform centrifugation of an ejaculate before embarking on a surgical recovery procedure to retrieve spermatozoa. Only when no spermatozoa are found in the pellet after centrifugation or when only immotile, non-viable spermatozoa are found is surgical sperm recovery indicated in order to avoid performing ICSI with spermatozoa with DNA damage.
Non-pharmacological treatments for chronic orchialgia: A systemic review
Published in Arab Journal of Urology, 2021
Kareim Khalafalla, Mohamed Arafa, Haitham Elbardisi, Ahmad Majzoub
A distinct subset of patients with CO are those who develop their symptoms following a vasectomy procedure for elective sterilisation. Chronic pain following this procedure, termed PVPS, has been identified as a late complication occurring in up to 15% of cases [51]. It is defined as intermittent or constant scrotal pain that occurs after a vasectomy procedure and stays for >3 months. The pain is typically aggravated with ejaculation, physical activity, and with pressure over the testis. Conservative measures of treatment can be tried first; however, if the pain persists for a long duration and affects the patients’ daily activities, then a vasectomy reversal procedure should be considered. A total of five studies including 131 patients who underwent vasectomy reversal due to PVPS were identified [36–40]. Overall, the reported improvement in pain after surgery was 69–93%. Lee et al. [38] linked pain improvement with the patency rates after surgery. In all, 22 patients who underwent vasectomy reversal for PVPS completed a study questionnaire and were assessed with a VAS pain score before and after the operation. The patency rate was 68.2% and the pain reduction was significantly more meaningful in the patent group, with a VAS mean (SD) difference of 6.0 (1.25) vs 4.43 (0.98) in the non-patent group (P = 0.014). This result highlights the relationship between vasectomy and the development of pain after the procedure and hints that an obstructive pathophysiology is the most likely mechanism for PVPS.
Vasectomy reversal utilizing fibrin glue
Published in Baylor University Medical Center Proceedings, 2019
G. Luke Machen, Ali M. Mahmoud, Colin E. Kleinguetl, Wencong Chen, Stephanie E. Harris, Erin T. Bird
More than 500,000 men in the USA have a vasectomy annually,1 and around 2% to 6% of these individuals later elect to have a vasectomy reversal.2 Over the last half century, the microsurgical approach to vasovasostomies has become the gold standard. Vasal anastomoses are typically performed using a single- or double-layer closure, with no difference demonstrated between the two in terms of success rates.3 Given the steep learning curve, long operative times, and frequent high cost of these operations, there have been attempts to increase efficiency, while still maintaining the success rates of traditional single- and double-layer anastomoses. One such example was described by Ho et al in 2005, in which they described a microscopic technique utilizing three full-thickness sutures and fibrin glue reinforcement for the anastomosis.4 At our institution, a similar technique has been used for >10 years. In this study, we describe our experience and results.
Review of the role of robotic surgery in male infertility
Published in Arab Journal of Urology, 2018
Mohamed Etafy, Ahmet Gudeloglu, Jamin V. Brahmbhatt, Sijo J. Parekattil
Vasectomy reversal was one of the most uniquely difficult challenging procedures in urology until the introduction of the operating microscope, which improved outcomes and performance of these procedures [15]. However, these techniques require dedicated training, experience, and a skilled microsurgical assistant. Robot-assisted microsurgical approaches with the da Vinci robotic platform can provide some advantages to overcome some of these challenges. Parekattil and Gudeloglu [12] reported comparable outcomes for robot-assisted microsurgical vasectomy reversal (110 patients) compared with the pure microsurgical technique (45 patients). The median clinical follow-up was 17 months. The median (range) duration from vasectomy in the robot-assisted vasovasostomy (RAVV) group was 7 (1–21) years and 6.5 (1–19) years in the microscopic group. The median age of the patients in the RAVV group was 41 years and 39 years in the microscopic group. A significantly better patency rate of 96% was achieved in the RAVV cases vs 80% in microscopic group. Pregnancy rates (within 1 year postoperatively) did not differ significantly between the two groups: 65% for the RAVV group and 55% for the microscopic group. Operative duration (skin to skin) started at 150–180 min initially for the first 10 cases of RAVV. However, the median (range) operative duration for RAVV overall was significantly decreased at 97 (40–180) min compared with microscopic group at 120 min. The median (range) operation duration for robot-assisted microsurgical vasoepididymostomy (RAVE), at 120 (60–180) min, was also significantly faster than the microscopic group at 150 min. Kavoussi [16] also reported similar outcomes when he compared both groups.