Marmar Joel L, Sharlip Ira, Goldstein Marc
Robert Wood Johnson Medical School at Camden, Camden, New Jersey 08103, USA.
J Urol. 2008 Apr;179(4):1506-9. doi: 10.1016/j.juro.2007.11.050. Epub 2008 Mar 4.
After undergoing vasectomy approximately 4% to 6% of men change their minds and desire more children. In the past they had 2 options: 1) vasectomy reversal and 2) sperm retrieval and intracytoplasmic sperm injection. However, in our practices we began to receive requests for another option: reconstructive microsurgery after failed percutaneous epididymal sperm aspiration.
In this report we combined our collective experience with 8 patients who requested reconstructive microsurgery after failed percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection.
Our intraoperative findings demonstrated minimal trauma to the epididymis resulting from percutaneous epididymal sperm aspiration. At surgery sperm were found in the testicular vas fluid in 10 of 16 vasal units, and vasovasostomy was possible on at least 1 side in 7 of 8 patients. Vasoepididymostomy was possible when needed. Of the 8 couples 4 achieved pregnancy (50%).
Vasovasostomy or vasoepididymostomy is possible after percutaneous epididymal sperm aspiration.
输精管结扎术后，约4%至6%的男性会改变主意并希望生育更多子女。过去，他们有两种选择：1）输精管复通术；2）取精及卵胞浆内单精子注射。然而，在我们的临床工作中，开始接到另一种选择的请求：经皮附睾穿刺取精失败后的显微重建手术。
在本报告中，我们结合了8例经皮附睾穿刺取精及卵胞浆内单精子注射失败后要求显微重建手术患者的共同经验。
我们的术中发现显示，经皮附睾穿刺取精对附睾造成的创伤极小。手术时，16个输精管单位中有10个在睾丸输精管液中发现精子，8例患者中有7例至少一侧可行输精管吻合术。必要时可行输精管附睾吻合术。8对夫妇中有4对成功受孕（50%）。
经皮附睾穿刺取精后可行输精管吻合术或输精管附睾吻合术。
