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The Infertile Male
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Thoraya Ammar, C. Jason Wilkins, Dean C.Y. Huang, Paul S. Sidhu
Epididymal obstruction is treated surgically. Vasoepididymostomy is a microsurgical technique where the epididymis is anastomosed to the vas bypassing the level of obstruction. Pregnancy can be achieved by 20%–40% of patients after vasoepididymostomy without using assisted reproductive techniques [9].
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.
Male infertility
Published in C. Yan Cheng, Spermatogenesis, 2018
Ryan Flannigan, Marc Goldstein
Epididymal obstruction is corrected via a vasoepididymostomy (VE). Several techniques have been described; however, the technique with the greatest patency rate is the longitudinal intussusception vasoepididymostomy (LIVE) technique (Figure 11.5). This technique has demonstrated a patency rate of 90% in experienced hands.54,55 Vasal obstruction is reconstructed by performing a vasovasostomy. Several techniques are described in the literature and are largely differentiated by single and multilayer techniques. A recent meta-analysis reported a mean patency rate of 89.4% for VVs and pregnancy rate of 73.0%. They also determined that no statistically significant differences existed in the patency of single vs multilayer techniques.56 However, the highest reported patency rate in the literature of 99.5% involves a multilayer technique involving six microdots to separate planning from suture placement of corresponding 10-0 nylon sutures to intricately reapproximate the mucosal layer, followed by six deep muscularis sutures using 9-0 nylon, six superficial 9-0 nylon sutures, and a final adventitial layer (Figure 11.6).57
Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial
Published in Arab Journal of Urology, 2019
Ahmed Farouk, Ahmed Tawfick, Mahmoud Reda, Ahmed M. Saafan, Waleed Mousa, Ahmed M. Tawfeek, Hassan Shaker
Fibrin sealant is a mixture of coagulation factors (thrombin and highly concentrated fibrinogen), with haemostatic and adhesive properties. It has been traditionally used for three major reasons in urological surgery. First, as a haemostatic agent, in open and laparoscopic partial nephrectomy, percutaneous nephrolithotomy, management of splenic injury, haemophilia and other coagulopathy, circumcision, and haemorrhagic cystitis. Second, as a urinary tract sealant, such as in procedures like LPP and open pyeloplasty, ureteric anastomoses, urethral reconstruction, simple retropubic prostatectomy, radical retropubic prostatectomy, vasovasostomy and vasoepididymostomy, bladder injury, and percutaneous nephrolithotomy tract closure. Lastly, as a tissue adhesive and healing promotor in Fournier’s gangrene, fistula closure, skin grafting, orchidopexy, penile chordee, and complex urethroplasty [11]. Therefore, at least theoretically, issues such as urinary leakage, urinoma formation and hospital stay can be addressed or decreased by adding fibrin glue to the anastomotic suture line.
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.
Vasectomy reversal: a review on outcomes using a loupe-assisted vasovasostomy approach
Published in The Aging Male, 2020
Manoj Ravindraanandan, Chea Tze Ong, Mohammed Elhadi, Wasim Mahmalji, Mehmood Akhtar
Two techniques are widely used for vasectomy reversal: vasovasostomy or vasoepididymostomy [7]. In 1902, the first human vasal repair was conducted by Martin, which was a milestone for mankind. Two decades later the first vasovasotomy was performed by Quinby and his associate, O’Connor [1]. This has inspired future surgeons to strive for more experience and technical improvement, with the help of advancing innovations and technology to improve surgical outcomes [7,8].