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Objective To summarize the clinical features and treatment of iatrogenic vas deferens injury in the inguinal region. Methods Between January, 2014 and June, 2018, we collected the data of 17 patients treated in our hospital for obstructive azoospermia resulting from a previous inguinal hernia surgery for analysis of their clinical features, findings by surgical exploration, and characteristics of vas deferens injuries. All the patients underwent microsurgical vas deferens anastomosis and the mid-term and long-term outcomes of the patients were followed up. Results Fourteen of the 17 patients underwent vasovasostomy or vasoepididymostomy successfully. The patients were followed up for a mean of 19.6±9.5 months after the microsurgeries, and recanalization was achieved in 13 patients with a mean sperm count of (33.1±25.6)×106/L; natural conception of the spouses was achieved in 6 cases after the surgeries. Conclusions Inguinal hernia surgery is one of the main causes of vas deferens obstruction to result in obstructive azoospermia, and recanalization can be achieved in the majority of such cases by microvasectomy.

Objective: To investigate the factors influencing the recovery from childhood inguinal herniorrhaphy (IH)-induced vas deferens obstruction following microscopic vasovasostomy., Methods: We retrospectively analyzed the clinical data on 41 cases of microscopic vasovasostomy for obstructive azoospermia in our hospital from July 2015 to September 2018. All the patients had a history of inguinal hernia treated by IH in the childhood. We performed scrotal ultrasonography, semen analysis and seminal plasma biochemistry to confirm vas deferens obstruction preoperatively. If sperm was observed for ≥2 times in semen examination after vasovasostomy, we considered the vas deferens successfully unobstructed., Results: Microscopic vasovasostomy was successfully completed in 39 of the cases, of which2 were lost to follow-up, with a follow-up rate of 94.8% (37/39). The patients, at the mean age of (25.54 ± 2.85) years and with body mass index (BMI) of (24.92 ± 2.79) kg/m2 and post-IH time of (18.97 ± 2.58) years, were followed up for (13.05 ± 3.74) months. Successful recovery from vas deferens obstruction was observed in 78.4% (29/37) of the patients after IH, 80.0% (16/20) in the < 26-year-olds, 76.5% (13/17) in the ≥26-year-olds (P = 0.795), 75.0% (12/16) in those with BMI < 24.92 kg/m2 , 81.0% (17/21) in those with BMI ≥24.92 kg/m2 (P = 0.807), 78.6% (11/14) in those with post-IH time of < 19 years, 18.3% (18/23) in those with post-IH time of ≥19 years (P = 0.982), 60.0% (12/20) in those with sperm and 82.4% (14/17) in those without sperm found intraoperatively (P = 0.428), 42.9% (3/7) in those treated by unilateral and 82.4% (26/30) in those by bilateral vasovasostomy (P = 0.027). Multivariate logistic regression analysis showed a close correlation between the operation side and postoperative recovery from vas deferens obstruction (P = 0.022)., Conclusions: For male patients undergoing microscopic vasovasostomy for childhood IH-induced vas deferens obstruction, the operation side is an independent factor influencing postoperative recovery, while age, BMI, post-IH time, and intraoperative presence or absence of sperm are not significantly correlated with it.

Objectives: To analyze the factors affecting the patency rate of microsurgical single-stitch longitudinal intussusception vasoepididymostomy and to explore the possible causes of failure. Methods: The clinical data of 87 patients with epididymal obstructive azoospermia who underwent microsurgical vasoepididymostomy from January 2015 to February 2018 in the First Affiliated Hospital of Fujian Medical University were analyzed retrospectively. We observed the patency rate postoperatively and evaluated several factors that possibly related to the patency rates. Preoperative examinations included peripheral blood chromosomes, Y chromosome microdeletions, sex hormones, seminal plasma, etc. After admission, microsurgical single-stitch longitudinal intussusception vasoepididymostomy was performed. During the follow-up, the semen was evaluated to assess the patency rate and the time to patency. Results: The patient's age ranged from 21 to 42 years and the mean age was(25±3) years. Infertility lasted for 1-8 years and the mean infertility time was(2.2±1.1) years. The longitudinal intussusception vasoepididymostomy was successfully completed in 80 patients , 5 cases gave up the anastomosis surgery because of multiple segment obstruction of the vas deferens, complete obstruction of the epididymis or testicular obstruction. Two cases underwent crossed vasovasostomy( sperm was present in the ejaculate in 1 case postoperatively). Of all the patients, 72 were successfully followed up. The follow-up time was 3-29 months, with an average of (12.0±1.7)months. Excluding 3 cases of follow-up time less than 12 months who still had no sperm in the ejaculate, 69 patients' data were in cluded in the final statistics, of which 50 cases with return of sperm in the ejaculate, the overall patency rate was 72.5%(50/69), concentration of sperm was 0.1-137.2 million/ml, and the mean concentration was(29±21) million/ml; with the progressive motile sperm rate ranging from 0-57.9%, the mean rate was(29.9±21.1)%. The patency rates of motile sperm and immobile sperm found in epididymal fluid during surgery were 82.2%(37/45) and 54.2%(13/24), respectively. The patency rate of bilateral and unilateral anastomoses was 77.6%(45/58) and 45.5%(5/11), respectively; the patency rate of caput anastomosis was 47.8%(11/23), and 84.8%(39/46) for corpus or caudal anastomosis. 17 patients achieved natural pregnancy postoperatively, the rate was 34.0%(17/50). Conclusions: The therapeutic effect of microsurgical single-stitch longitudinal intussusception vasoepididymostomy is satisfactory. The motile spermatozoa in epididymal fluid, bilateral surgery and corpus or caudal anastomosis can improve the patency rate postoperatively.

In the past two decades, with the rapid development of assisted reproductive technology and particularly the technological advances in male infertility microsurgery, many obstructive azoospermia-related infertile couples can now acquire the chances of natural pregnancy via reconstruction of the seminal tract. This article highlights the latest advances in surgical reconstruction of the seminal tract for the treatment of obstructive azoospermia, such as the application of laparoscopic and robotic techniques, with a discussion on microsurgical epididymal sperm aspiration and preservation, potential use of absorbable sutures or the bio-suture tape for microsurgical anastomosis in the management of obstructive azoospermia.

Objective: To investigate the treatment of azoospermia induced by iatrogenic injury to the bilateral vas deferens., Methods: We retrospectively analyzed 11 cases of azoospermia caused by iatrogenic injury to bilateral vas deferens. The patients were aged 20－33 years, all diagnosed with azoospermia preoperatively and none with a history of pelvic operation. Seven of them had received bilateral inguinal hernia repair and the other 4 undergone bilateral orchidopexy in the childhood., Results: Intraoperative exploration of the bilateral inguinal region was performed in all the patients. Bilateral vas deference atresia was found in the inguinal canal in 6 cases, which was treated by microscopic vasovasostomy following removal of the atresic segment. Vas deferens residual was observed in or near the deep inguinal ring in the other 5 cases, with the distal vas deferens inaccessible, which was treated by bilateral vasovasostomy in 3 cases and unilateral vasovasostomy in 2 (for longer defect segment than could be anastomosed) following combined laparoscopic exploration of the abdominal cavity. The patients were followed up for 3－12 months postoperatively, during which sperm were detected in 7 cases, with sperm concentration ranging from 0.4×10⁶/ml to 35×10⁶/ml and grade a+b sperm from 15% to 46%., Conclusions: For the diagnosis of azoospermia, especially in patients with no history of pelvic operation, special attention should be paid to iatrogenic injury to the vas deferens. For the treatment of the disease, non-tension vasovasostomy is essential and, when necessary, the vas deferens can be reconstructed by changing its anatomical path and shortening its length.

Objective: To evaluate the efficacy of microsurgical vasectomy reversal on patients after vasectomy., Methods: In the study, 41 patients after vasectomy were admitted for microsurgical vasectomy reversal. The mean (range) age was 45 (29 to 66) years for the men. The mean duration of obstruction was 12 years. All the patients were seen by the surgeon for a complete history and physical examination. Semen analyses proved azoopermia, and their serum levels of sexual hormone were normal. They were all offered scrotal exploration. Microvasovasostomy was performed if the sperm was found in the material coming from the proximal vas lumen. The decision for microvasoepididymostomy was made during surgery, if the fluid was creamy, containing only debris or there was no fluid whatsoever when the vas was milked toward the cut end. Microvasovasostomy was performed in 40 patients, of whom 6 were with lateral microvasoepididymostomy and 1 with bilateral microvasoepididymostomy. The initial semen analysis was then done after usually 3 months postoperatively. Patency was arbitrarily defined as>10 000 sperm/mL in ejaculate in at least one semen analysis after surgery. Postoperative patency rate and postoperative impregnation rate were followed., Results: The 41 patients were followed up for 3 to 72 months, and 5 cases were lost. In the 28 patients who had obstructions for less than 15 years, 3 were lost. Sperm was found by semen analysis in 21 patients. Their sperm density was 2×10(6) to 46×10(6) sperms/mL and motility was 0% to 60%. The semen analysis revealed azoospermia in 2 patients after 12 months, who were advised to undergo intracytoplasmic sperm injection. Natural conception occurred in 6 patients followed for more than 12 months. The overall patency rate was 84% (21/25). Among the patients with a follow-up of >6 months, the natural paternity rate was 29% (6/21). In the 13 patients who had obstructions for more than 15 years, 2 were lost. The patency and pregnancy rates were 64% (7/11) and 14% (1/7) respectively. Their sperm density was 0.02×10(6) to 30× 10(6) sperms/mL and motility was 0% to 43%., Conclusion: Microsurgical vasectomy reversal is an effective method to treat vasal obstruction due to vasectomy. The patency and pregnancy rates are related to the time of vasectomy. The patency and pregnancy rates are higher in patients with obstruction for less than 15 years than those for more than 15 years.

Objective: To investigate the changes and variation of serum antisperm antibodies (AsAb) from the men who received vasovasostomy 2 years after one of three methods of male sterilization, and evaluate the relationship between serum AsAb and pregnancy rate., Methods: Sperm reappearance, serum AsAb and pregnancy rate were investigated in 88 subjects who underwent reversal operation 2 years after one of three methods of male sterilization at 3, 6, 12 and 24 months post vasovasostomy., Results: There was no significant difference in positive rate of AsAb among groups of vasovasostomized men post one of three methods of sterilization, and between groups before and post vasovasostomy and between groups with and without sperm reappearance, respectively. The positive rate, intensity (percentage of motile sperm coated with beads) and type of serum AsAb had no influences on pregnancy. No significant difference was observed in positive rate of AsAb between pregnant group and non-pregnant group. The pregnancy rate of the group in which sperm concentration was more than 20 x 10(6)/ml was apparently higher than that of the group in which sperm concentration was less than 20 x 10(6)/ml., Conclusion: The serum AsAb and their positive rate can not be eliminated or decreased by vasovasostomy post male sterilization. The serum AsAb has no influence on pregnancy. There is a close relationship between sperm quality and pregnancy post vasovasostomy.

Objective: To investigate the effect of vasostomy on apoptosis in the male rat spermatogenic cells after vasoligation., Methods: Model of vasoligation and vasostomy in male rat was established, and then terminal deoxynucleotidyl transferase-mediated dUTP nick labelling technique to detect the apoptosis of spermatogenic cells at 4, 8, 12, 16 weeks after vasostomy., Results: The number of apoptotic cells in vasostomy group was significantly lower than that of vasoligation group since 8 weeks after vasostomy(P < 0.05). The number of apoptotic cells in 8 and 12 weeks after vasostomy were significantly higher than that in prevasoligation(P < 0.05). 16 weeks after vasostomy, the number of apoptotic cells restored to the level same as that in prevasoligation stage., Conclusion: Vasostomy can reverse the apoptosis of spermatogenic cells due to vasoligation.

The objective of this study was to explore the change of Bcl-2 and Bax gene expression in rat spermatogneic cells after vasostomy. A rat model with vasoligation and vasostomy was set up and then used for detecting the protein expression of Bcl-2 and Bax gene at 4, 8, 12, 16 weeks after vasostomy by means of immunohistochemistry. Sixty rats were randomly distributed into three groups named vasoligation group (VG), vasostomy group(VOG) and sham-operation group(SOG) respectively. The results showed that the Bcl-2 protein expression in VOG group increased gradually and came to be significantly higher than that in VG group 8 weeks after vasostomy, and it's level was the same as that in SOG group at the 12th week. The bax protein expressions in VG and VOG groups were significantly higher than that in SOG group, but there was no difference between VOG and VG groups. In conclusion, the change of Bcl-2 protein expression observed in this study is indicative of the anti-apoptosis function of Bcl-2 gene in both the status of being vasoligated and vasostomized, whereas the consistent Bax protein expression before and often the repatency of the vas suggests further researches into its effect on apoptosis of spermatogenic cells.

To improve curative effect, we performed aspermia of epididymal blockage on 21 patients with epididymal tubule vasostomy using microsurgical technique between 1985 and 1994. In the 21 patients 20 showed sperm, and 18 increased sperm numbers over 4 x 10(7)/ml postoperation. The wives of 12 patients became reproductive. The selection of 3 different anastomotic ways using microsurgical technique could obviously improve curative effect, according to the dilated degree of epididymal tubule. The selection of anastomotic ways and liquid-passed test of deferential dust was also discussed.

Microsurgical techniques were carried out in reanastomosis of the vas deferens, autotransplantation and replantation of the testis, adrenal autotransplantation with attached blood vessels, anastomosis between the internal spermatic lymphatic vessel and vein, and internal spermatic venous diversion. Double-layer and single-layer anastomosis were adopted in vasovasostomy. It was observed that the former technique seemed a little better but the difference was not statistically significant in regard to the patency and pregnancy rate (P greater than 0.05). Testicular autotransplantations were carried out in two cases, each with bilateral cryptorchism and they were both adults at the time of operation. Postoperative follow-up turned out that spermatogenesis didn't happen. Replantation of a testis was applied to a case with complete traumatic severance of both funiculi within the scrotum. The patient regained his normal endocrine and spermatogenetic functions postoperatively. The techniques of adrenal autotransplantation with attached blood vessels and that of the anastomosis between lymphatic vessel and vein are discussed.