Hou Yi, Zhang Ying, Li Guang, Wang Wenxiang, Li Hai
Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, PR China.
Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, PR China.
Urology. 2018 Dec;122:97-103. doi: 10.1016/j.urology.2018.08.007. Epub 2018 Aug 22.
To assess the therapeutic efficacy and safety of microsurgical epididymal cystectomy for the treatment of epididymal cystic lesions in young men with fertility requirements and the impact of this surgery upon sperm quality and epididymal function.
We prospectively evaluated the therapeutic outcomes, complications, safety and efficacy of microsurgical epididymal cystectomy and the impact of microsurgery upon sperm parameters. All patients were followed-up 3, 6 and 12 months after surgery to investigate sperm count, motility, morphology, neutral α-glucosidase, improvement of symptoms, recurrence, and complications.
Palpated cyst pain was evident in 32 out of 51 patients. Pathologists identified 29 spermatoceles and 22 epididymal cysts. Mean operation time was 39.27 ± 5.98 minutes, and the mean length of postoperative hospital stay was 2.02 ± 0.35 days. After surgery, scrotal pain disappeared in 80.4% of patients (41/51). A significantly higher rate of pain disappearance was observed in patients with palpated pain than those without palpated pain. Insignificant difference was seen in terms of sperm count, motility, sperm morphology or neutral α-glucosidase between preoperation and postoperation at 1-year follow-up. Sperm count and NGA in patients with an epididymal cystic lesions > 2.5 cm were significantly increased after surgery. The rate of complications was 7.3%. No cyst recurrence was observed during follow-up.
Microsurgical epididymal cystectomy does not impact upon sperm count, motility, morphology, or epididymal function and is a safe and effective surgical modality for young men with fertility requirements. Local palpated pain on the epididymal cyst is recommended as an optional surgical indication.
评估显微外科附睾囊肿切除术治疗有生育需求的年轻男性附睾囊性病变的疗效和安全性，以及该手术对精子质量和附睾功能的影响。
我们前瞻性评估了显微外科附睾囊肿切除术的治疗效果、并发症、安全性和有效性，以及显微手术对精子参数的影响。所有患者在术后3、6和12个月进行随访，以调查精子数量、活力、形态、中性α-葡萄糖苷酶、症状改善情况、复发情况和并发症。
51例患者中有32例可触及囊肿疼痛。病理学家鉴定出29例精液囊肿和22例附睾囊肿。平均手术时间为39.27±5.98分钟，术后平均住院时间为2.02±0.35天。术后，80.4%的患者（41/51）阴囊疼痛消失。可触及疼痛的患者疼痛消失率明显高于无可触及疼痛的患者。在1年随访时，术前和术后的精子数量、活力、精子形态或中性α-葡萄糖苷酶方面无显著差异。附睾囊性病变>2.5 cm的患者术后精子数量和中性α-葡萄糖苷酶显著增加。并发症发生率为7.3%。随访期间未观察到囊肿复发。
显微外科附睾囊肿切除术对精子数量、活力、形态或附睾功能无影响，是有生育需求的年轻男性安全有效的手术方式。建议将附睾囊肿局部可触及疼痛作为手术的可选指征。
