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Abstract

Volume 15, Issue 1 (January 2013) 15, 49–55; 10.1038/aja.2012.80

The evolution and refinement of vasoepididymostomy techniques

Peter T Chan

Department of Urology, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec H3A 1A1, Canada. mcgillsperminator@yahoo.com

Correspondence: Professor PT Chan, (mcgillsperminator@yahoo.com)

Received 15 July 2012; Revised 13 September 2012; Accepted 13 September 2012 Advance online publication 19 November 2012

Abstract

Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy (VE). Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE (LIVE) in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the preoperative evaluation along with the techniques of various VE will be described in this article.

Keywords:longitudinal intussusception vasoepididymostomy (LIVE); intracytoplasmic sperm injection (ICSI); male infertility; microsurgery; obstructive azoospermia; vasoepididymostomy (VE)

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