Scovell Jason M, Mata Douglas A, Ramasamy Ranjith, Herrel Lindsey A, Hsiao Wayland, Lipshultz Larry I
Scott Department of Urology, Baylor College of Medicine, Houston, TX.
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
Urology. 2015 Apr;85(4):809-13. doi: 10.1016/j.urology.2014.09.005. Epub 2015 Feb 16.
To investigate the association between the presence of sperm in the vasal fluid during vasectomy reversal (VR) and postoperative patency.
We performed a systematic review and meta-analysis of the English-language literature reporting on the association between the presence of sperm in the intraoperative vasal fluid (ie, whole or parts vs none) and patency (ie, patent or not) after microsurgical vasovasostomy for men with obstructive azoospermia due to vasectomy. Odds ratios (OR) and 95% confidence intervals were calculated to quantify the strength of the association reported by each study. Meta-analysis was performed using a random-effects model.
Four case series and 2 retrospective cohort studies of a total of 1293 eligible patients were identified. The mean age at VR was 37.8 years, and the mean obstructive interval was 7.1 years. The unadjusted OR of postoperative patency was 4.1 times higher (95% confidence interval, 2.3-7.3) given the presence of intravasal sperm or sperm parts as opposed to their absence at the time of VR (Q = 3.4; df = 5; P = .6; I(2) = 22%). The pooled OR should be interpreted with caution as only the 2 retrospective cohort studies reported meaningful data on this association. Because of inconsistent reporting, analysis of other vasal fluid characteristics (eg, consistency) and outcomes (eg, pregnancy) was not possible.
The presence of whole sperm or sperm parts in the vasal fluid during VR is positively associated with postoperative patency. Our review highlights the poor methodological quality of existing evidence and underscores the need for more thorough follow up and higher standards of reporting in future studies.
探讨输精管复通术（VR）时输精管液中精子的存在与术后通畅性之间的关联。
我们对英文文献进行了系统评价和荟萃分析，这些文献报道了因输精管结扎导致梗阻性无精子症的男性在显微外科输精管吻合术后，术中输精管液中精子的存在情况（即有全部或部分精子与无精子）与通畅性（即通畅与否）之间的关联。计算比值比（OR）和95%置信区间，以量化每项研究报道的关联强度。采用随机效应模型进行荟萃分析。
共纳入4个病例系列和2项回顾性队列研究，总计1293例符合条件的患者。VR时的平均年龄为37.8岁，平均梗阻时间为7.1年。与VR时输精管内无精子或精子部分相比，输精管内有精子或精子部分时，术后通畅性的未调整OR高出4.1倍（95%置信区间，2.3 - 7.3）（Q = 3.4；自由度 = 5；P = 0.6；I² = 22%）。由于仅有2项回顾性队列研究报道了关于这种关联的有意义数据，因此对汇总OR的解释应谨慎。由于报告不一致，无法分析其他输精管液特征（如黏稠度）和结局（如妊娠）。
VR时输精管液中存在完整精子或精子部分与术后通畅性呈正相关。我们的综述强调了现有证据的方法学质量较差，并强调未来研究需要更全面的随访和更高的报告标准。
