LAUSR

INTRODUCTION AND OBJECTIVE: Single-armed two-suture vasoepididymostomy (VE) technique has been widely used, which proved to be one of effective and safe surgical options for the treatment of obstructive azoospermia (OA) caused by primary epididymal obstruction. Factors which may affect outcomes of VE has been reported. However, some of those factors become not much important to the outcomes of VE with the improvement of surgical technic and the accumulating experience of surgeons. We focused on the new-interested factors of BMI and age affecting the surgical outcome of VE and evaluated their clinical value in improving the patency rate. At the same time, other factors what might affect the outcomes were re-evaluated. METHODS: 181 azoospermia patients cause by primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon (KH) at Peking University Third Hospital, Beijing, China from September 2014 to September 2017 were followed up consecutively. Body mass index (BMI), age, together with other five factors such as methods of bilateral or unilateral anastomosis, anastomosis sites, the motility and quantity of sperms found in epididymal fluid intraoperatively, what were possibly related to the patency rates were analyzed. RESULTS: Among 181 patients, 159 (87%, 159/181) patients were followed through either telephone calls or interview. 22 patients were lost to follow-up. The mean follow-up time was 27 (12~48) months. Patency was defined by finding sperms in semen analyses or natural impregnation during the follow-up. The patency rate was 73.0% (116/159). Then, with the logistic regression multifactor analysis, we confirmed that factors of BMI and age were related to a higher patency rate (P [ 0.008 and 0.028, respectively). A younger age and a lower BMI score appeared to be associated with a higher patency rate (OR [ 3.531 and 2.352, 95% CI [ 1.397, 8.924 and 1.095, 5.054, respectively). CONCLUSIONS: BMI and age were confirmed to be independent influencing factors for the outcomes of microsurgical VEs on humans when the technology matured and the surgeons were experienced. We suggest patients take microsurgical VE before 28 years old and control their BMI under 26 to achieve better surgical outcomes. Other factors analyzed in this study appeared no significant relationship with patency.