输精管结扎术后35例再通者排出精子的动态观察

作者观察了输精管结扎术后35例自发性再通者在18个月内精液中精子密度和活动率的动态变化,显示输精管再通者中90.6%发生在术后9月以内,未避孕的再通者夫妇中再孕占1/3,而71.4%的再孕发生在手术一年以后。6例自愿接受再次输精管结扎者术时加用断端电灼或包埋,均在0.5～6月精子完全消失.     

输精管结扎术四种不同残端处理与节育效果的比较性研究

８１６例自愿接受输精管绝育术男子按照节育手术常规施行输精管结扎术，受术者随机均分为４个队列，分别施行不同的输精管残端处理方法：（１）单纯两断端结扎；（２）结扎加精索筋膜隔离；（３）结扎加苯酚涂灼；（４）电灼。术中以１：３０００新洁尔灭溶液每侧输精管５ｍｌ行精囊灌注，术后３年４种方法精子消失率分别为９０．０％（１８０／２００），９４．１％（１７５／１８６），９３．７％（１７９／１９１）及９４．５％（１７２／１８２），术后并发症为０．４％（３／８１６）。在此对输精管结扎术后自发再通问题进行了讨论，并认为１：３０００新洁尔灭溶液行精囊灌注是安全可行的。     

显微镜下“双钳法”输精管结扎术临床分析

目的探讨显微镜下"双钳法"输精管结扎术疗效。方法显微镜下"双钳法"输精管结扎术26例,行阴囊中缝处无血管区纵行切口,先行右侧输精管结扎,用一把皮内输精管固定钳钳夹固定输精管,再用另一把皮内输精管固定钳钳夹交替将输精管移至近皮肤切口处,在放大10倍显微镜下仔细分离,电刀精准止血。切断输精管后,在显微镜下仔细辨认输精管断端的外形,用高频电刀电凝烧灼输精管的断端,结扎近端输精管残端放回,结扎远端输精管残端,行阴囊筋膜穿洞后,钳夹结扎线拉出筋膜外固定。同法处理左侧输精管。结果术中未发生出血血肿;皮下淤血2例,发生率7.70%;阴囊血肿0例,发生率0%;术后切口感染1例,发生率3.85%;发生痛性结节0例,发生率0%;术后再通1例,发生率3.85%;附睾淤积症1例,发生率3.85%。结论显微镜下"双钳法"输精管结扎术是一种安全、高效的手术方法,值得临床推广。     

输精管外膜横断治疗输精管结扎术后痛性结节——附6例报告

输精管结扎术后,常遇到结扎部位遗留大小不等的硬结,有些硬结伴有顽固的疼痛,造成患者食欲减退,消瘦乏力、性欲减退、阳萎、失眠等神经官能症症状,甚至不能工作。输精管痛性结节是输精管结扎术后的主要并发症,占术后并发症的1/4。其病因国内刘国振认为主要是手术操作不够细致轻巧,剥离输精管时损伤了附近纤细的血管和神经,或结扎时连带了输精管以外的纤维组织所引起。叶成通等报告了21例输精管结扎后痛性结节,17例均发现有神经纤维包埋到结扎残端之中。在冶疗方面方法较多,如普鲁长因加醋酸氢化可的松局部封闭、单纯抗生素局部注射或敷贴中药等。经各种非手术疗法无效者,多数学者主张手术切除硬结,再扎或吻     

改良的输精管单层显微吻合术与输精管全层吻合术疗效比较

目的 比较行改良输精管单层显微吻合术与全层显微吻合术的疗效.方法 回顾性分析2003年6月～2010年7月40例输精管结扎男性患者行输精管吻合再通手术,单层吻合术17例,全层吻合23例,2个月后随访精液中有精子表示再通成功.结果 输精管结扎时间＜ 36个月患者,再通后精液中都有精子存在.结扎时间为36 ～96个月,再通率分别为88％和91％,结扎＞96个月后手术,再通率更差.单层吻合的平均手术时间为96min,全层吻合手术时间平均为181min.结论 大多数情况下,改良的单层输精管吻合简单,快速.对于大多数患者来说,两种手术方式再通成功率无明显差异,单层吻合术可作为首选治疗.     

无支架输精管—层吻合术(附35例报告)

输精管结扎术后吻合方法很多,其效果报道复通率76.7％～100％,妊娠率52.63％～75.56％不等。自1980年以来,我院应用无支架一层缝合法,取得满意效果。现报告如下。资料与方法 (一)一般资料:本组35例,年龄28～45岁,平均36.4岁,输精管结扎方法,以单纯切断结扎为主。输精管结扎离复通时间6个月～14年,绝大多数在5年内。复通原因:子女意外死亡或伤残需再育者20例;再婚后要求生育者2例;结扎后出现痛性结节、附睾郁积症、性功能障碍,治疗无效经当地计划生育部门同意而行复通者13例。 (二)手术方法:硬膜外麻醉下,于阴囊正中作1-2cm切口,用输精管固定钳夹住结扎段输精管并提出切口,沿结扎结节向两端分离1cm,在距结     

输精管吻合口双支架法

输精管吻合术成功的要素之一是输精管两断端精确对合。所以 ,有人主张用软材料或者硬材料作吻合口支架 ,试图保持输精管吻合口通畅 ,不狭窄、不扭曲、不成角 ,减少术后吻合口梗阻 ,输送精液通畅。笔者自 1995年以来用细钢丝线作输精管吻合口临时支架缝合输精管两断端 ,又采用无病变旷置的输精管结扎结节作输精管吻合口后壁永久性支架4 0例[1] ,临床效果满意 ,现报告如下。资料与方法一、一般资料1.受术者资料 :受术原因 :输精管绝育术后子女夭折要求再育者 2 8例 ,附睾瘀积症长期保守治疗未愈者 9例 ,性功能障碍者 3例。年龄 :2 4～ 30岁者 …     

显微外科吻合术治疗医源性腹股沟输精管梗阻

目的总结腹股沟区手术输精管损伤后的再通治疗经验。方法2005年7月至今收治11例有双侧腹股沟手术史的梗阻性无精子症患者,手术探查腹股沟区均证实输精管损伤,完全离断4例,断端以细弱瘢痕相连的7例,采用手术显微镜下精微对位多层吻合输精管再通术。结果全部病例中10例行再通手术,7例术后精液检测发现精子。结论腹股沟区手术损伤后的输精管再通手术难度较大,显微镜下精微对位多层吻合输精管再通术是治疗腹股沟区输精管损伤的首选方案。     

应用显微外科技术输精管吻合术10例报告

近年来,我们采用显微外科技术施行输精管吻合术10例。在局麻下手术。用三指法将输精管结扎部与精索分离,挤于皮下,于阴囊外侧血管稀疏处用输精管分离钳将皮肤刺一小孔,分离提出精管结扎处,并将结节提出切口表面,锐性分离结扎端上下输精管各1cm,距结扎部0.3～0.5cm处切断输     

应用显微外科技术输精管吻合分析

目的报道显微外科技术行输精管吻合术的方法、临床效果及相关注意事项。方法硬膜外麻醉或局麻下切断、结扎的输精管断端,使其上、下保持锐性游离0.5 cm输精管,在10倍显微镜下看清管腔,缓慢注入生理盐水3~5 ml。确认管腔通畅后,进行吻合。结果36例全部复通。结论显微外科技术行输精管吻合操作方便,成功率高。     

输精管结扎术残端处理方式与再通关系的研究

用７种残端处理技术完成的２３７３例输精管结扎术的一项前瞻性研究表明，术后２年随访时共有７８例查见精子，其中２７例配偶受孕，精子阳性率为３．２９％，再孕率１．１４％。各种术式的精子阳性率：附睾端开放加包埋０．５５％，两端单纯结扎１．４１％，结扎加筋膜包埋２．６３％，石碳酸烧灼３．１７％，精囊端折叠３．７１％，结扎加电灼４．７５％和不作包埋的附睾端开放７．５３％。经统计学处理各种术式的精子阳性率之间差异有非常显著意义（Ｐ＜０．０００１）。由不同手术者完成的相同术式结果分析表明，除石碳酸烧灼组以外，其余各组皆无组内差异。７个残端处理组的并发症发生率有显著差异（Ｇ＝２０．９６，Ｐ＜０．０１）、其中不作包埋的附睾端开放组并发症发生率达２．１７％，折叠组的出血和感染等发生虽少，但术后近期局部结节反应发生率达４．７７％。本研究表明，输精管残端处理方式的不同可能影响术后节育效果和安全性，但手术者经验和技术水平也起很大作用。     

Vasectomy reversal.

Although the pace is slower, the need for reversal of the vasectomy procedure increases as vasectomy increases in popularity. Reasons for requesting vas reanastomosis and restored fertility are various. Recently, there have been significant advances in the surgical techniques for vasectomy reversal to restore fertility after previous voluntary sterilization by bilateral vasectomy, leading to improved results. Anatomical and physiological considerations, results, and the surgical technique of vasovasostomy are reviewed. Reviewing the literature on reported experiences with vasectomy-reversal operations it can be found that after vasectomy various authors have reported that sperm cells have returned to the ejaculate in 30-98% of the series. Spontaneous recanalization of the vas does occur in 1-2% of the cases after vasectomy. In the surgical technique of vasovasostomy, a non-splinted technique with surgical ocular loupes of 4 power magnification and 8, 6-zero prolene sutures was used, and the entire procedure is described in detail. The reasons for the marked discrepancy between the presence of sperm after vasovasostomy and the pregnancy rates continues unknown. The improved results with vas reanastomosis recently reported by urologists using various techniques may be related to the elimination of the use of exteriorized intra-vasal splints that usually were removed several days or weeks postoperatively. Currently, long-term comparative results are unavailable.     

Vasectomy

Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.     

Fibrin glue vasal anastomosis compared to conventional sutured vasovasostomy in the rat

Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue ("Tisseel", Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (less than 3 mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy. The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.     

Indications and surgical technic of vasectomy for male sterilization]

A survey among German urologists regarding indications for male vasectomy for sterilization purposes yielded the following findings. Most vasectomies are performed for social reasons, that is, family planning, followed by medical and finally genetic reasons. Generally, for vasectomy for medical reasons the wife's gynecologist is consulted. For genetic indications, the physicians of both spouses are usually consulted. Most physicians stated that the age of the patient is important in the decision to perform a vasectomy, however mostly in the case of a social indication, much less so for the other categories. Number of children is also considered significant in the vasectomy decisions. Nearly 75% of urologists stated a certain minimum number of children as the prerequisite for this procedure: at least 2, at least 1, and at least 3, respectively. Almost all physicians required a written agreement of both spouses. Most vasectomies were performed on an outpatient basis with local anesthesia. Almost all physicians order a histopathological study of the resected sperm duct ends. Only a very small percentage (roughly 5%) flush the spermatic ducts with different substances. This attitude is difficult to understand in view of the sometimes very late onset of azoospermia (intervals of more than 1 year). The authors report good results with flushing the ducts using an aqueous nitrofurantoin instillation solution not commercially available at present. 1/4 of urologists reported cases of spontaneous recanalization.     

A different female partner does not affect the success of second vasectomy reversal

The aim of the study was to determine whether the pregnancy rate with the same female partner or younger partners was higher compared with different or older partners after undergoing repeated vasectomy reversal. A total of 44 patients were enrolled in the present study. The cause of reversal in patients with the same partner was the desire to have more children in 14 cases, the loss of a child in 7 cases, and the desire for a son in 7 cases. Patients were asked about pregnancy and childbirth during follow-up visits and by telephone or mail. Following microsurgical vasectomy reversal, patency was observed in 38 men (86.4%). Twenty-five of the couples (56.8%) achieved pregnancy without any artificial conception technique. We did not observe a significant difference in the pregnancy rate (57.1% vs 56.3%, P=.954) between patients with the same or a different female partner. In the multivariate model used, partner age was the only independent predictor for pregnancy. Patients with a partner less than 35 years old had a 4.1-fold greater chance (odds ratio, 4.13; 95% confidence interval, 1.06-16.10; P=.041) of pregnancy than those with a partner 35 years old or older. The area under the receiver operating characteristics curve for partner age was 73.0% (95% confidence interval 56.8-89.2, P=.011). Our findings suggest that repeat microsurgical vasectomy reversal still remains a reasonable choice for patients with different female partners. However, it should be considered that the likelihood of achieving pregnancy after repeat vasectomy reversal may decrease with advancing age of the female partner.     

Seminal sediment investigation in azoospermia?

In cases of azoospermia especially after vasectomy the investigation of the seminal sediment investigation is necessary. Exclusive on this way it is possible to find some side dispersed spermatozoa. The described case deals with a pregnancy about 48 days following vasectomy. Postoperative the sperm sediment investigation was not performed. In the following judicial hearing the doctor justified himself, that there do'nt exist any special direction in different textbooks of andrology as well as of urology. But this case demonstrates the necessary of the seminal sediment, which is the most important andrological investigation after vasectomy. For this it is not necessary to find special directions, this is common use.     

Laser-assisted vasectomy reversal: experience in 32 patients

A Food and Drug Administration approved protocol using a microsurgical carbon dioxide laser to assist in vasectomy reversal was instituted in January 1987. Between January 1987 and December 1988 the procedure was performed on 32 patients, 31 of whom submitted sperm and were available to evaluate. Success rates for sperm in the ejaculate in patients who underwent vasectomy less than 10 years previously were excellent, approaching 95%. The pregnancy rate in this group was 35%. In patients whose vasectomy was performed more than 10 years before reversal the results were much poorer. The success rate for sperm in the ejaculate was only 36% and the pregnancy rate was only 9%. The advantage of laser-assisted vasectomy reversal is that it is a simpler technical procedure that requires considerably less time than a 2-layer microsurgical technique. There were no significant complications, sperm granuloma, or even significant swelling or hematoma in any patient operated upon. Laser-assisted vasectomy reversal is at least equal to conventional microsurgical techniques and definitely easier to perform surgically.     

Paternity after bilateral vasectomy

OBJECTIVES: To determine whether the occurrence of recanalization depends on the technique of vasectomy. MATERIALS AND METHODS: A survey was conducted among Dutch urologists using a questionnaire in which information was gathered about the surgical procedure, postoperative complications, results of semen analysis after vasectomy, time between vasectomy and occurrence of paternity, results of semen analysis after paternity, performance of revasectomy, results of histological examination of the revasectomy specimen and whether the event had changed the protocol of the urologists. RESULTS: In all, 32 cases of paternity after vasectomy were registered. Surgical techniques and the criteria for a successful vasectomy differed among the responding urologists. There was a difference in time to paternity between men who did and did not correspond with the criteria. In most cases, semen analysis after paternity showed numerous motile sperm. Six men initiated litigation after paternity and the vasectomy protocol was modified by five urologists. CONCLUSION: Paternity consequent on recanalization can occur at any time after bilateral vasectomy and does not depend on the surgical procedure or criteria for sterility. Because of the major consequences of paternity after vasectomy for both the man and urologist, accurate information about the possibility of recanalization should be given to the man beforehand.     

Recanalization following vasectomy

Most authors have not differentiated between early and late recanalization following bilateral vasectomy for sterilization. Their reported recanalization rates probably reflect only early recanalization. Long-term follow-up semen examinations are required to document late recanalization. This regimen may be unacceptable to some patients and physicians. No symptomatic postvasectomy complication preceded the recanalization.