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* These authors contributed equally
The present protocol describes a vessel-sparing, longitudinal intussusception vasoepididymostomy using readily available single-needle sutures in China, a safe and effective procedure, which may improve patients' patency and natural pregnancy rates.
The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of epididymal OA since 2000. There are two challenges in classic microscopic vasoepididymostomy. First, anastomosis of the vas deferens and epididymis is performed with double-needle sutures. However, there is a lack of good-quality and cost-effective double-needle sutures in China, which leads to increased difficulty and poor success rates of anastomosis. Second, the separation of the vas deferens does not retain vasculature, although the vas deferens vasculature plays an important role in the blood supply to the vas deferens, epididymis, and testis. This affects the blood supply to the anastomotic area and epididymis.
Therefore, this team has made innovative improvements to address these problems. Good-quality, cost-effective, single-needle sutures, which are easy to purchase in China and other countries, were used in microsurgical longitudinal intussusception vasoepididymostomy. This can optimize the operation procedure and shorten the operation time while ensuring the success rate of the anastomosis. The surgical method of preserving the vas deferens vessels was innovatively proposed because the etiology of epididymal OA is mostly inflammatory in China. The protection of the blood supply to the vas deferens and epididymis is maximized using microsurgical forceps to separate and protect the vasculature. Patency reached 81.7% in the postoperative follow-up, indicating a better surgical treatment effect.
The number of infertile couples has been increasing annually; OA occurs in 20%-40% of azoospermia cases in men of reproductive age1. Epididymal obstruction accounts for approximately 30% of OA cases and is one of the most common obstruction sites. However, this proportion may be higher in China2,3. The treatment for OA varies depending on the site of the obstruction. The common causes of OA include vasectomy, genitourinary tract infection, genitourinary tuberculosis, iatrogenic injury, and idiopathic obstruction. The etiology of OA in China is mostly epididymal obstruction caused by gen....
The study was approved by the First Affiliated Hospital of Sun Yat-Sen University. Diagnostic criteria, surgical indications, and contraindications were in accordance with the Guidelines for Diagnosis and Treatment of Andrology and Expert Consensus of the Chinese Society of Andrology and the European Association of Urology Guidelines for Sexual and Reproductive Health. A patient would be excluded from this study if the female partner had medical conditions that affect fertility.
1. Instr.......
A study included 92 men who were diagnosed with azoospermia secondary to epididymal obstruction in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China, and who underwent operation between January 2017 and December 2018. The average age of the 92 males was 30.77 ± 5.38 years (range: 20-47 years) (Table 1). All men underwent the bilateral vessel-sparing, modified, single-armed technique for LIVE, and the mean operation time was 223.59 ± 31.73 min. No postoperative complicati.......
Genitourinary tract infections and epididymitis are common causes of epididymal OA. VE has become an important method to treat epididymal OA and has been applied in clinics since 20004. Anastomosis of the vas deferens and epididymis is performed with double-needle sutures without preserving vessels of the vas deferens in the classic MVE6,8,9. Because double-needle sutures are expensive and not readily ava.......
This study was supported by Clinical Research Training Program, the East Division of the First Affiliated Hospital of Sun Yat-Sen University (No.2019002, No.2019008), and the Foundation of National Health Commission of the People's Republic of China key laboratory of Male Reproduction and Genetics (No.KF202001).
....Name | Company | Catalog Number | Comments |
0.9% sodium chloride solution | Guangdong Otsuka Pharmaceutical Co. LTD | 21M1204 | Dilute antibiotics, irrigate. |
1 mL syringe | Kindly Medical, Shanghai | K20210826 | inject diluted methylene blue or 0.9% sodium chloride solution |
1% iodophor | Guangzhou Qingfeng Disinfection Products Co., LTD | Q/QFXD2 | Disinfect the surgical area. |
10-0 polypropylene sutures | Ethicon, LLC | REBBES | Used when anastomosing. |
3-0 polyglactin 910 sutures | Ethicon, LLC | RGMCLH | Suture skin incisions at the end of surgery. |
5-0 polyglactin 910 sutures | Ethicon, LLC | RBMMPQ | Suture skin incisions at the end of surgery. |
8-0 polypropylene sutures | Ethicon, LLC | RDBBLS | Used when anastomosing. |
9-0 polypropylene sutures | Ethicon, LLC | RABDTE | Used when anastomosing. |
F16 urinary catheter | Well Lead Medical, Guangzhou | 20190612 | Drainage of urine due to long operation time. |
micro haemostatic forceps | Shanghai Surgical Instrument Factory | W40350 | Used in surgical procedures |
micro scissors | Cheng-He,NingBo | HC-A008 | Used in surgical procedures |
micro tweezers | Cheng-He,NingBo | HC-A002 | Used in surgical procedures |
microneedle holder | Cheng-He,NingBo | HC-GN006 | Used in surgical procedures |
ophthalmic scissors | Shanghai Surgical Instrument Factory | Y00040 | Used in surgical procedures |
polyglactin 910 sutures | Ethicon, LLC | RBMMPQ | Suture skin incisions at the end of surgery. |
silk braided non-absorbable suture | Ethicon, LLC | SB84G | ligate the broken end of the vas deferens |
skin marker | Medplus Inc. | 21120206 | Mark surgical incisions and suture sites. |
surgical microscope Carl Zeiss S88 | Carl Zeiss | Carl Zeiss S88 | Enlarge your field of vision during surgery. |
vas-fixation clamp | Shanghai Surgical Instrument Factory | JCZ220 | Used in surgical procedures |
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