呂謹亨¹  黃志賢^{1, 2, 3} 黃奕燊^{1, 2, 3} 林登龍^1,2,3  陳光國^1,2,3

¹臺北榮民總醫院 泌尿部

²國立陽明大學醫學院 泌尿學科³書田泌尿科學研究中心

Chin-HengLu¹, William J.S. Huang^1,2,3, I-Shen Huang^1,2,3, Alex T.L. Lin^1,2,3, Kuang-Kuo Chen^1,2,3

¹Department of Urology, Taipei Veterans General Hospital

²Department of Urology, School of Medicine and ³Shu-Tien Urological Research Center, National Yang-Ming University

 

Purpose: Non-iatrogenic obstructive azoospermia (OA) includes ejaculatory disorders or obstructions in internal reproductive tracts. Besides the etiology of congenital bilateral absence of vas deferens (CBAVD), high blockage at rete testis, or very distal obstruction below internal inguinal rings, the blockade could potentially identified by scrotal exploration and treated with epididymo-vasostomy (EV). The purpose of this study is to analyze the patient cohort with non-iatrogenic, non-traumatic OA who underwent scrotal exploration with or without EV anastomosis in our institution.

 

Materials and Methods: We retrospectively reviewed patients with non-iatrogenic, non-traumatic OA and received scrotal exploration at Taipei Veterans General Hospital from 1995 to 2016. OA was confirmed by semen analysis and needle testis biopsy in all patients. The operation for EV anastomosis was two-stitch longitudinal intussusception technique Patients who had prior vasectomy or history of vas deferens trauma/injury were excluded. The age, hormone profile, semen parameters, obstruction level, semen quality at proximal end and patency rate were analyzed.

 

Results: Totally 96 patients with mean age 35.4±5.6 y/o were collected. The obstruction levels at scrotal exploration were: 17 patients were bilateral high blockage, 7 patients were bilateral low blockage, 2 had CBAVD variants, 1 had CUAVD variants (segmental agenesis), 49 patients were at bilateral epididymides including head (11), body (18), tail (20), 4 patients had proximal vas deferens obstruction, 10 patients had one side epididymis and the other side vas deferens obstruction and 6 patient had one side high blockage with the other side epididymis obstruction. There were 68 patients received EV anastomosis. For cases with available semen follow up data, mean patency rate was 79.5% (31/39) 6 months post EV anastomosis. The mean semen pH for all patients was 7.76 ± 0.52 (range 6.5-8.5). Patients with CBAVD or CUAVD variants had lower semen pH (6.67 ± 0.1, p= 0.001). Patients with bilateral high blockage had higher FSH (p=0.003) and LH (p=0.007) levels. The patency rate was higher when there was motile sperm (58.0%) (29/50) rather than immotile sperm (10.0%)(1/10) (p= 0.012) which was found in peri-operational cutting end fluid aspiration. There was no significant difference of patency rate between one side and two side EV anastomosis.

 

Conclusions: The bilateral high and low blockage rates were 25% that EV could not be performed at scrotal exploration for non-iatrogenic non-traumatic OA. The mean patency rate for EV anastomosis was 79.5%. The patency rate was higher when motile sperm rather than immotile sperm was found in peri-operational cutting end fluid aspiration. Patients who presented lower semen pH had higher risk for CBAVD or CUAVD variants.