The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization:a systematic review and meta-analysis  

作　　者：Young Eun Yoon Hyung Ho Lee Sung Yul Park Hong Sang Moon Dong Suk Kim Seung-Hun Song Dae Keun Kim 

机构地区：[1]Department of Urology,Hanyang University College of Medicine,Seou104763,Korea [2]Department of Urology,National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do 10444,Korea [3]Department of Urology,Fertility Center of CHA Gangnam Medical Center,CHA University,Seou106135,Korea [4]Department of Urology,CHA Seoul Station Fertility Center,CHA University,Seou104637,Korea [5]Department of Urology,School of Medicine,Graduate School,Hanyang University,Seou104763,Korea

出　　处：《Asian Journal of Andrology》2019年第1期67-73,共7页亚洲男性学杂志（英文版）

摘　　要：This study comprises a systematic review and meta-analysis of micmsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia.A comprehensive literature search was performed using Medline,Embase,and the Cochrane library that included all studies related to microsurgical vasoepididymostomy.Keywords included “vasoepididymostomy,”“epididymovasostomy,”“epididymal obstruction,”and “epididymis obstruction.”Event rate and risk ratio (RR)were estimated.Patency rate and pregnancy rate were investigated.The analysis comprised 1422 articles,including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017.The overall mean patency rate was 64.1%(95%confidence interval [CI]:58.5%-69.3%;F=83.0%),and the overall mean pregnancy rate was 31.1%(95%CI:26.9%-35.7%;I^2=73.0%).We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38%(95%CI: 1.21%-1.57%;P <0.00001).A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR =1.17%;95%CI: 1.01%-1.35%;P =0.04).Patients with motile sperm in epididymal fluid exhibited an RR of 1.53%(95%CI:1.11%-2.13%;P =0.01)with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally,anastomosing a larger caudal area,and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.

关 键 词：AZOOSPERMIA META-ANALYSIS VASOEPIDIDYMOSTOMY 

分 类 号：R[医药卫生]