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A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration
Zheng Li
Shanghai Jiaotong University First People's Hospital
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Urology.
Background: To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE).
Methods: From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3–36) months.
Results: Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9%, 40.7%, 36.4%, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11±2.74 months. In the first six months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3–36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis.
Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within one year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.
Keywords
obstructive azoospermia, male infertility, vasoepididymostomy, patency, pregnancy
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CURRENT STATUS: Published
Version 2
Posted 20 Jan, 2020
Published
On 12 Aug, 2020
No community comments so far
Reviewers invited
Invitations sent on 30 Jan, 2020
Editor assigned
On 15 Jan, 2020
Submission checks complete
On 14 Jan, 2020
Editor invited
On 14 Jan, 2020
No comments provided
Editorial decision: Major revision
On 17 Dec, 2019
Reviewer #2 agreed
On 02 Dec, 2019
Review #2 received
Received 02 Dec, 2019
Review #1 received
Received 09 Oct, 2019
Reviewer #1 agreed
On 30 Sep, 2019
Reviewers invited
Invitations sent on 27 Sep, 2019
Editor assigned
On 05 Sep, 2019
Submission checks complete
On 08 Aug, 2019
Editor invited
On 08 Aug, 2019
First submitted
On 31 Jul, 2019
Metrics
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Subject Areas
Urology & Nephrology
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This preprint is under consideration at BMC Urology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration
Zheng Li
Shanghai Jiaotong University First People's Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 20 Jan, 2020
Published
On 12 Aug, 2020
No community comments so far
Reviewers invited
Invitations sent on 30 Jan, 2020
Editor assigned
On 15 Jan, 2020
Submission checks complete
On 14 Jan, 2020
Editor invited
On 14 Jan, 2020
No comments provided
Editorial decision: Major revision
On 17 Dec, 2019
Reviewer #2 agreed
On 02 Dec, 2019
Review #2 received
Received 02 Dec, 2019
Review #1 received
Received 09 Oct, 2019
Reviewer #1 agreed
On 30 Sep, 2019
Reviewers invited
Invitations sent on 27 Sep, 2019
Editor assigned
On 05 Sep, 2019
Submission checks complete
On 08 Aug, 2019
Editor invited
On 08 Aug, 2019
First submitted
On 31 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Urology.
Background: To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE).
Methods: From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3–36) months.
Results: Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9%, 40.7%, 36.4%, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11±2.74 months. In the first six months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3–36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis.
Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within one year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.
Figure 1
Figure 2