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  • Title: Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule.
    Author: Silber SJ.
    Journal: Fertil Steril; 1978 Nov; 30(5):565-71. PubMed ID: 720645.
    Abstract:
    A new microscopic technique for vasoepididymostomy is described. Conventional approaches to epididymal obstruction rely on the formation of a fistulous tract after the walls of the vas deferens are grossly sutured to the outer tunic of the epididymis; such methods have a low success rate. With a direct and accurate end-to-end anastomosis of the inner lumen of the vas deferens specifically to the epididymal tubule there is a greater likelihood of normal patency. Furthermore, such an anastomosis can be performed at the lowest possible level of the epididymis, allowing a greater opportunity for sperm maturation. A new, direct anastomosis of the epididymal tubule to the mucosa of the vas deferens is described as performed on 14 men with epididymal obstruction. In this method, about 1 cm of the epididymis is dissected and cut transversely, as low as possible above the obstruction, if it can be visualized nder the x10 or x16 operating microscope. This cut will expose 3-10 epididymal tubules. The one bearing the sperm fluid can be ascertained by examining smears. If no sperm are present, another section .5 cm higher is examined until sperm gush out, although it is important to cut as low as possible in the epididymis to insure motile sperm. The vas is mobilized enough to reach the epididymis without tension. Dissection of both vessels can be done with x2.5 ocular loupes. Anastomosis, under operating microscope, must be performed from the posterior aspect first, using 9-0 or 10-0 nylon, then carefully suturing from outside to inside the epididymal tubule and from inside to outside the vas mucosa, so that the two lumens approximate perfectly. The outer muscularis of the vas is then sutured to the epididymal tunic with 10 to 12 9-0 nylon-interrupted sutures. The man may be discharged in 1-2 days, advised to rest for 1 week. Monthly sperm counts need be repeated until normal motile sperm appear. In this preliminary series of 14 men, 11 had normal motile sperm counts. 1 patient did not have motile sperm: his anastomosis was in the head of the epididymis. The 2 with low counts had not shown a reliable flow of sperm fluid from the anastomosed tubule.
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