Analysis Of Factors Affecting Postoperative Recovery Rate In Patients With Epididymal Obstructive Azoospermia

Objective: To investigate the factors associated with postoperative recanalization rates in patients with epididymal obstructive azoospermia.Methods: This article retrospectively analyses the data related to 76 patients with epididymal obstructive azoospermia who underwent microscopic Epididymal vas deferens anastomosis at our hospital between January 2018 and June 2021.The mean age of the patients was 30.99±4.95 years,body mass index was 23.13±3.02（kg/m 2）.Among them,16 patients had a clear history of genitourinary tract infection,42 had a history of epididymitis,and six had a previous history of fertility.Six patients had previous childbearing history.All patients’ serum sex hormones were within normal targets.All patients had a normal sex life after marriage and had been infertile for more than 1 year after marriage.All patients’ spouses had undergone gynaecological examination and none had female factors causing infertility.Of the 76 patients,47 patients had bilateral anastomosis,29 patients had unilateral anastomosis,22 patients had anastomosis of the head of the epididymis and 54 patients had anastomosis of the tail of the body.Intraoperative microscopic examination of the epididymal fluid showed a large number of motile sperm in 53 patients and occasional motile sperm in the epididymal fluid in 23 patients.The pulsatile system was preserved intraoperatively in 49 patients and not in 27 patients.A chi-square test was used to compare the above four groups to investigate the intraoperative factors affecting the postoperative recanalisation rate of epididymal obstructive azoospermia.Results: Excluding those who lost contact,a total of 76 patients were followed up in this group for a period of 3-33 months.Each patient returned to the hospital for post-operative semen quality analysis.51 of these patients were examined for sperm,and the post-operative recanalisation rate was 67.1%.The recanalisation rates were 80.8% and 44.8% for bilateral and unilateral anastomoses respectively.The recanalisation rates for epididymal head anastomosis and body caudal anastomosis were 36.3% and 79.6% respectively.The intraoperative microscopic finding of more active sperm in the epididymal fluid versus occasional active sperm was 69.8% and 60.9%,respectively.The intraoperative recanalisation rate was 69.3% and 62.9% with and without preservation of the pulsatile system,respectively.Conclusion:1.Intraoperative selection of bilateral anastomosis and caudal anastomosis of the epididymal body can improve the postoperative recanalization rate of EOA patients.2.The number of motile spermatozoa in the epididymal fluid under microscopic examination and whether or not the pulsatile system was preserved intraoperatively did not significantly affect the postoperative recanalization rate.3.Although whether or not the vascular system is preserved intraoperatively does not affect the postoperative recanalization rate,it is still necessary to preserve the vascular system as much as possible intraoperatively.Preserving the vascular system can better perform its physiological function and effectively reduce the incidence of postoperative complications,which is beneficial to patients’ postoperative recovery.