Modification Of Microsurgical Vasoepididymostomy Treating Epididymal Obstructive Azoospermia

ObjectiveMicrosurgical vasoepididymostomy,which is an effective approach to manage epididymal obstructive azoospermia,could improve male fertility.Microsurgical longitudinal intussusception vasoepididymostomy(LIVE)had been widely used to treat epididymal obstructive azoospermia since 2004.However,10-0 double armed sutures were not available in some countries,China for instance.Our previous study analyzed and compared the advantages and disadvantages of each VE methods based on our preclinical animal research and modified LIVE into single armed 2-suture longitudinal intussusception vasoepididymostomy(SA-LIVE).Furthermore,we modified the surgical protocol as vasal vasculature preserving SA-LIVE.The present study aimed to analyze the feasibility,safety and effectiveness of modified SA-LIVE and vasal vasculature preserving SALIVE.Material and MethodsEOA patients were admitted to hospital after assessment of couple's fertility after ethical approval and informed consent.The patients underwent modified SA-LIVE or vasal vasculature preserving SA-LIVE.Patency was defined as sperm found in the ejaculate after discharged,the primary study end point was natural pregnancy.Data analysis included descriptive statistics,t-tests,and chi-square.P values <0.05 were considered significant.ResultsFrom March 2015 to December 2018,134 EOA patients underwent modified SA-LIVE.The average time to patency was 4.11 months,no patients achieved patency one year later post operation.The patency rate for bilateral anastomosis was 58.9%,and for unilateral anastomosis was 40.7%(P=0.090).The natural pregnancy rate for bilateral anastomosis was 32.1%,and for the unilateral anastomosis was 20%(P=0.442).The natural pregnancy rate was 33.3% for distal anastomosis,while proximal anastomosis was 0%(P=0.090).No severe adverse events or complications were observed.From March 2019 to October 2019,45 patients were randomly divided into two groups:modified SA-LIVE group(control group)and vasal vasculature preserving SA-LIVE group(experimental group).The average operation duration in control group was 65 mins,and it was 72 mins in experimental group(p=0.255).The patency rate was 52.5% in control group,and it was76.2% in the experimental group(P=0.370).The natural pregnancy rate was 0% in control group,and it was 31.2% in experimental group(P=0.047).There were no severe adverse events or complications in both groups.ConclusionsCompared with the previous reports of LIVE,the modified SA-LIVE could achieve a favorable patency rate and natural pregnancy rate,and the patency was expected to be within one year.We presented a novel technique for preserving the vasal vasculature during SA-LIVE.The preliminary outcomes showed these techniques to be safe with higher patency rate and natural pregnancy rate.However,a well-designed prospectively randomized controlled clinical trial with a larger sample size to further explore the efficacy and safety of vasal vasculature preserving SA-LIVE is required.