Microsurgical vasoepididymostomy: a prospective randomized study of 3 intussusception techniques in rats.
OBJECTIVE
Vasoepididymostomy is a technically challenging but cost-effective treatment for obstructive azoospermia. We evaluated the outcomes of 3 intussusception vasoepididymostomy techniques, namely 3 suture triangulation, 2 suture transverse and a new 2 suture longitudinal technique.


METHODS
Male Wistar rats were randomized into 4 experimental and 1 control groups. After 3 weeks of vasal obstruction bilateral vasoepididymostomy was performed. In group I, 3 sutures were placed in triangular fashion. In group II, 2 sutures were placed perpendicular to the tubule. In group III, 2 sutures were placed longitudinal to the tubule. The tubules were then opened in the direction of the needles and anastomosed to the vasa. After 5 months patency was evaluated in blinded fashion.


RESULTS
The functional patency rate (presence of motile sperm in the vas) was 64%, 64% and 93% in groups I to III, respectively (p <0.001). As evaluated by methylene blue retrograde vasography toward the epididymis, the mechanical patency rate was similar for the 3 techniques, that is 86%, 86% and 93% in groups I to III, respectively. The sperm granuloma rate was significantly lower in group III (36%, 21% and 0% in groups I to III, respectively, p <0.001).


CONCLUSIONS
Transverse 2 suture vasoepididymostomy has a patency rate similar to that of the 3 suture technique. Our new 2 suture longitudinal technique, which allows a larger opening in the epididymal tubule for anastomosis, is superior to the 2 and 3 suture techniques with respect to the patency and sperm granuloma rates.
Chan
Peter T K
PT
Cornell Institute for Reproductive Medicine, Center for Male Reproductive Medicine and Microsurgery, New York Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA.
Li
Philip S
PS
Goldstein
Marc
M
D000714:Anastomosis, Surgical; D000818:Animals; D004822:Epididymis / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013536:Suture Techniques; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014649:Vas Deferens / Q000601:surgery*