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Abstract

Volume 21, Issue 1 (January 2019) 21, 67–73; 10.4103/aja.aja_59_18

The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta-analysis

Young Eun Yoon1, Hyung Ho Lee2, Sung Yul Park1, Hong Sang Moon1, Dong Suk Kim3, Seung-Hun Song3, Dae Keun Kim4,5

1 Department of Urology, Hanyang University College of Medicine, Seoul 04763, Korea
2 Department of Urology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do 10444, Korea
3 Department of Urology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
4 Department of Urology, CHA Seoul Station Fertility Center, CHA University, Seoul 04637, Korea
5 Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul 04763, Korea

Correspondence: Dr. DK Kim (kdg070723@gmail.com)

Date of Submission 03-Mar-2018 Date of Acceptance 12-Jun-2018 Date of Web Publication 14-Aug-2018

Abstract

This study comprises a systematic review and meta-analysis of microsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia. A comprehensive literature search was performed using Medline, Embase, and the Cochrane library that included all studies related to microsurgical vasoepididymostomy. Keywords included “vasoepididymostomy,” “epididymovasostomy,” “epididymal obstruction,” and “epididymis obstruction.” Event rate and risk ratio (RR) were estimated. Patency rate and pregnancy rate were investigated. The analysis comprised 1422 articles, including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017. The overall mean patency rate was 64.1% (95% confidence interval [CI]: 58.5%–69.3%; I2=83.0%), and the overall mean pregnancy rate was 31.1% (95% CI: 26.9%–35.7%; I2=73.0%). We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38% (95% CI: 1.21%–1.57%; P < 0.00001). A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR = 1.17%; 95% CI: 1.01%–1.35%; P = 0.04). Patients with motile sperm in epididymal fluid exhibited an RR of 1.53% (95% CI: 1.11%–2.13%; P = 0.01) with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.

Keywords: azoospermia; meta-analysis; vasoepididymostomy

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