A 35 year old gentleman case of obstructive azoospemia underwent Vaso-Eididymal Anastomosis.
SURGICAL PROCEDURE:
High hemiscrotal vertical incision given extending into the external inguinal ring.The testis was delivered out and the vas was isolated.The scarred vasal tissue was excised and freshened till healthy margins.The proximal vasal patency was confirmed with saline flush test.The head of the epididymis was chosen for VEA. On microscopy the tubules were looking healthy , turgid and yellowish.
SURGICAL PROCEDURE:
High hemiscrotal vertical incision given extending into the external inguinal ring.The testis was delivered out and the vas was isolated.The scarred vasal tissue was excised and freshened till healthy margins.The proximal vasal patency was confirmed with saline flush test.The head of the epididymis was chosen for VEA. On microscopy the tubules were looking healthy , turgid and yellowish.
The vas was brought till the head region and approximated to the tunic with 8-0 prolene. A longitudinal 2-suture intussusception VEA approach was done. A two parallel double-arm sutures were placed in the distended epididymal tubule with 10- Nylon suture (Ethicon 3313); however, the needles are not pulled through. A nick was made on the distended tubule and the epididymal fluid was tested for sperm. The fluid was tested positive for the sperms and given for cryopreservation. The 2 needles within the epididymal tubule are pulled through, and all 4 needles are placed through the vas lumen at the allowing the epididymal tubule to be intussuscepted into the vasal lumen, completing the anastomosis . The vasal adventitia is then approximated to the epididymal tunic with 8-0 nylon.
VEA is the microsurgical procedure for treatment of epididymal obstruction. It is the most difficult microsurgical procedures for the treatment of male infertility and requires excellent microsurgical skills.
In India ; most cases of epididymal obstructions are post inflammatory( due to recurrent epididymitis).So we encounter a lot of fibrosis in that region as contrary to what Western population see .In Developed nations , VEA is most often performed for vasectomy reversal or the block is focal. So the results of VEA are high in US/European countries.( 80-90%) whereas here it is 30-50%.
We also get the successful outcome in only 30-40% cases. Most of the cases need ART afterwards in some or other forms.
So we advise strongly to all people who undergo VEA, vasectomy reversal, varicocelectomy for severe/azoospermia for cryopreservation.These cryopreserved sperms can be used for future ICF and ICSI if need be .
We have seen some patients having genetic problems like AZF c gene disorders where there is continuous deterioration of sperm counts.Such patients ( if they have coincidental varicoceles) undergo varicocelectomy can have adverse outcome not because of the surgical complication but because of the underlying genetic disorder.
Also the complex microsurgical reconstructive procedures may not succeed so the sperm banking is an essential step to be undertaken.
VEA is the microsurgical procedure for treatment of epididymal obstruction. It is the most difficult microsurgical procedures for the treatment of male infertility and requires excellent microsurgical skills.
In India ; most cases of epididymal obstructions are post inflammatory( due to recurrent epididymitis).So we encounter a lot of fibrosis in that region as contrary to what Western population see .In Developed nations , VEA is most often performed for vasectomy reversal or the block is focal. So the results of VEA are high in US/European countries.( 80-90%) whereas here it is 30-50%.
We also get the successful outcome in only 30-40% cases. Most of the cases need ART afterwards in some or other forms.
So we advise strongly to all people who undergo VEA, vasectomy reversal, varicocelectomy for severe/azoospermia for cryopreservation.These cryopreserved sperms can be used for future ICF and ICSI if need be .
We have seen some patients having genetic problems like AZF c gene disorders where there is continuous deterioration of sperm counts.Such patients ( if they have coincidental varicoceles) undergo varicocelectomy can have adverse outcome not because of the surgical complication but because of the underlying genetic disorder.
Also the complex microsurgical reconstructive procedures may not succeed so the sperm banking is an essential step to be undertaken.
We are one of the few centers in Andhra Pradesh who regularly perform VEA,vasectomy reversal and mcirosurgical varicocelectomy as part of andrological reconstructive surgeries. We routinely call our embryologist during such procedure. We employ either sperm fluid from the vassal end/epididymal tubule or TESA ( during varicocelectomy) to use for cryopreservation.
Thanks for sharing the report on remember to cryopreserve the sperms before any male infertility procedures .
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