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      Comparative evaluation of double- and single-armed two-suture longitudinal intussusception techniques in microsurgical vasoepididymostomy: An updated systematic review and meta-analysis

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          Abstract

          Background

          This study aimed to compare the outcomes of double−armed two−suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single−armed two−suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates.

          Methods

          Data from patients with EOA who underwent two−suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random−effects model, and weighted mean differences were reported.

          Results

          A total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63–72%), with a patency time of approximately 4.63 months (95% CI: 4.15–5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31–46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double−armed and single−armed LIVE techniques.

          Conclusion

          The single−armed LIVE is a potential alternative surgical option when high quality double−needle sutures are not easily accessible.

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          Most cited references31

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          Intussusception vasoepididymostomy with longitudinal suture placement for idiopathic obstructive azoospermia.

          Surgical reconstruction is an important treatment option for obstructive azoospermia. Vasoepididymostomy results have primarily been described in men with previous vasectomy. We evaluated vaso-epididymal anastomosis outcomes using a 2-suture microsurgical intussusception technique with longitudinal suture placement in men with idiopathic obstructive azoospermia. Between April 2007 and May 2009, 24 men with idiopathic obstructive azoospermia underwent 2-layer vaso-epididymal anastomosis using a 2-suture intussusception technique. Two double armed 10-zero polyamide sutures were placed parallel to each other longitudinally along the epididymal tubule to intussuscept the tubule into the lumen of the vas deferens for the inner layer of the anastomosis. Patency was assessed by return of sperm in the semen. A total of 23 men with a mean age of 31 years provided at least 1 postoperative semen sample. All had a mean 67-month history of primary infertility. In 11 men (48%) patency was noted a mean of 6.6 months (range 3 to 15) after surgery. One patient reported pregnancy by natural conception. Men with motile sperm in the epididymal fluid and those with bilateral surgery were more likely to have a patent anastomosis. Within 1 year after surgery approximately half of the men who underwent longitudinal vaso-epididymal anastomosis for idiopathic azoospermia had return of sperm in the ejaculate. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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            Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men.

            Vasoepididymostomy remains one of the most technically challenging procedures in all of microsurgery. The technique has evolved from an end-to-end, to an end-to-side technique, then to intussusception end-to-side methods. We recently reported the superiority of 2-suture longitudinal and 3-suture triangulation intussusception techniques in rats. In the present study we report our results in humans. We evaluated all vasoepididymostomies performed by 1 surgeon from January 1992 until the present for patency, pregnancy and for disappearance of sperm after initial return of sperm to the ejaculate. We recorded the results of 153 consecutive vasoepdidymostomies done by 1 surgeon (MG) from January 1992 until February 2004. Four techniques were used, namely end-to-end (EE), end-to-side (ES), 3-suture triangulation intussusception (TIVE) and 2-suture longitudinal intussusception (LIVE). Data collected included technique, months of followup, sperm density, motility and morphology (WHO 1992 criteria), pregnancy outcome and late failures. Late failures were defined as having return of sperm to the ejaculate after vasoepididymostomy and then becoming azoospermic on at least 2 subsequent semen analyses. A total of 153 men underwent bilateral vasoepididymostomies. The most recent 17 were LIVE, preceeded by 38 TIVE, 32 ES and 66 EE. Mean followup for the groups were 17.2 (LIVE), 70.8 (TIVE), 116.7 (ES) and 140.2 (EE) months, respectively. Intact sperm were seen in the ejaculates of 12 men (80%) in the LIVE group, 16 in the TIVE group (84%), 20 in the ES group (74%) and 30 men in the EE group (73%). Motile sperm were found in the ejaculates of 10 of 15 (67%) in the LIVE group, 13 of 19 (68%) in the TIVE group, 10 of 27 (37%) in the ES group and 20 of 41 (49%) in the EE group (p =0.2). Mean times for return of sperm to the ejaculate were 2.9, 2.8, 2.8 and 3.5 months, respectively. Pregnancies were reported by 4 men in the LIVE group all before 12 months, 6 in the TIVE group and 3 were by 12 months, and 4 each by the ES and EE groups with 3 and 2 by 12 months (p =0.07). Thus far, there have been no late failures in the LIVE group, only 1 in the TIVE group (8%), 5 in the ES group (50%) and 6 in the EE group (30%) (p =0.04). Although vasoepididymostomy remains a technically demanding microsurgical procedure, recent technical innovations of TIVE and LIVE offer better or comparable outcomes compared with EE and ES procedures with the use of fewer sutures, which simplifies the performance of the anastomosis. In addition, the late failure rate is lower with the use of the intussusception techniques (LIVE and TIVE) with only 1 late failure in 22 men with return of sperm to the ejaculate procedures (4%) compared with 11 of 30 (37%) in the nonintussusception groups (p =0.006).
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              Causes of suspected epididymal obstruction in Chinese men.

              To explore the causes of epididymal obstruction in China and the success of reconstructive surgery.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ResourcesRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: SupervisionRole: Validation
                Role: Data curationRole: Formal analysis
                Role: SoftwareRole: Writing – review & editing
                Role: Software
                Role: Formal analysisRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ResourcesRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                5 February 2024
                2024
                : 19
                : 2
                : e0298019
                Affiliations
                [001] Department of Andrology and Sexual Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
                Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ HZ and ST also contributed equally to this work.

                Author information
                https://orcid.org/0000-0002-2443-0836
                Article
                PONE-D-23-34614
                10.1371/journal.pone.0298019
                10843031
                38315686
                a67220fb-2ed4-483d-adc2-7218acaffc20
                © 2024 Xiao et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 October 2023
                : 21 December 2023
                Page count
                Figures: 8, Tables: 1, Pages: 15
                Funding
                Funded by: Young and Middle-Aged Key Personnel Training Project of the Fujian Provincial Health Commission
                Award ID: 2019-ZQN-62
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100017954, Fujian Provincial Finance Department;
                Award ID: BPB-TSX2021
                Award Recipient :
                This work was supported by the Young and Middle-Aged Key Personnel Training Project of the Fujian Provincial Health Commission (No. 2019-ZQN-62) and the Fujian Provincial Finance Project (No. BPB-TSX2021).
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Biology and Life Sciences
                Cell Biology
                Cellular Types
                Animal Cells
                Germ Cells
                Sperm
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Semen
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Semen
                Biology and Life Sciences
                Physiology
                Body Fluids
                Semen
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Metaanalysis
                Physical Sciences
                Mathematics
                Statistics
                Statistical Methods
                Metaanalysis
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Obstetric Procedures
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Biology and Life Sciences
                Physiology
                Cardiovascular Physiology
                Angiogenesis
                Intussusception
                Biology and Life Sciences
                Developmental Biology
                Angiogenesis
                Intussusception
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Microsurgery
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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