Pelviscrotal vasovasostomy: refining and troubleshooting

Area of Science:

• Urology
• Andrology
• Surgical Innovation

Background:

• Inguinal surgery, particularly childhood herniotomy, can lead to vas deferens obstruction in 26.7% of cases.
• Traditional open surgery for vas deferens anastomosis in the inguinal region presents significant technical challenges and high morbidity.
• Previous work introduced the Shaeer pelviscrotal vasovasostomy, a laparoscopic approach bypassing the inguinal segment.

Purpose of the Study:

• To evaluate the efficacy and safety of performing bilateral Shaeer pelviscrotal vasovasostomy in a single session.
• To present troubleshooting for potential obstacles encountered during the procedure.
• To assess the outcomes of this technique in patients with azoospermia due to inguinal vas deferens obstruction.

Main Methods:

• A cohort of 25 patients with azoospermia caused by inguinal vas deferens obstruction underwent either unilateral (15 patients) or bilateral (10 patients) Shaeer pelviscrotal vasovasostomy.
• Patients were followed for a period of 1 year post-surgery.
• Analysis included reoperation in cases of persistent azoospermia to identify and resolve anastomosis issues.

Main Results:

• A significant sperm concentration (11.88–17 million/ml) was achieved in 17 out of 25 patients (68%).
• Reoperation for persistent azoospermia allowed for the identification and resolution of obstacles to successful anastomosis.
• The procedure demonstrated feasibility for simultaneous bilateral repair.

Conclusions:

• Shaeer vasovasostomy is a practical and effective method for addressing inguinal vas deferens obstruction.
• The technique allows for reliable anastomosis, simultaneous bilateral repair, and is associated with lower morbidity (wound healing, hernia) and shorter convalescence.
• This approach offers a valuable alternative to traditional open surgical methods for vasal obstruction.