AB149. A novel single-armed technique for microsurgical vasoepididymostomy: the reverse single-armed 2-suture longitudinal intussusception

OBJECTIVE: To evaluate the clinical outcomes of reverse single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Additionally, to identify factors that might be associated with improved pregnancy rates following SA-LIVE for obstructive azoospermia. DESIGN: Retrospective cohort study. MATERIAL AND METHODS: From July 2007 to March 2012, 192 patients with epididymal obstructive azoospermia (EOA) had undergone SA-LIVE at our hospital. Patency was assessed by confirm the sperm in the semen. The outcomes and clinical findings of microsurgical procedure including site of microsurgical anastomosis, epididymal fluid findings and sperm cryopreservation were documented and evaluated. RESULTS: The mean age of the patients was 32.3 years (range: 23-50 years) in our study. The mean follow-up period was 17 months (range: 6-26 months). The patency rate was 35.3%, 50.6% and 61% for the sites of caput anastomosis, corpus anastomosis, caudal anastomosis, respectively. The overall patency rate was 53.1% (102/192) at the follow-up of 6 to 24 months, the total and natural pregnancy rates were 22.4% (43/192) and 19.8% (38/192). The natural pregnancy rate was 25.0% for bilateral surgery, 6.5% (the site of caput anastomosis), 14.3% (the site of corpus anastomosis), 27.4% (the site of caudal anastomosis), and 34.7% (flowing fluid with motile sperm), respectively; and the rate for flowing fluid with motile sperm was 79.6%. Meanwhile, the sperm during VE was banked and five cases were treated by ICSI using frozen sperm collected at operation. CONCLUSIONS: When specialized double-armed microsurgical suture was not available, the reverse SA-LIVE was a valuable, effective alternative microsurgical approach that would let infertile couple to achieve a favorable patency and pregnancy. It also reduces the operation time and the cost of microsurgical materials, and obviates the suture crossing. SUPPORT: This work was supported by Science and Technology Commission of Shanghai Municipality (No: 10JCI409900), National Basic Research Program of China (No: 2011CB944504, 2010CB945200).