Allameh Farzad, Hosseini Jalil, Qashqai Hamidreza, Mazaherylaghab Hamzeh
Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Electronic Address:
Men's Health and Reproductive Health Research Center (MHRHRC), Reconstructive Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Fertil Steril. 2019 Oct;13(3):240-244. doi: 10.22074/ijfs.2019.5664. Epub 2019 Jul 14.
Two-six percentage of vasectomized men will ultimately seek vasectomy reversal, which late stricture and obstruction after operation are relatively common. To find a method for improving vasovasostomy outcomes, we used intra-operative local mitomycin-C (MMC) preventing possible fibrosis and stricture.
In this randomized clinical trial, 44 patients were assigned to two groups randomly during a one-year study and the data of 40 patients were analyzed. The patients were followed up for 6 months after surgery. The case group (n=19) was treated by vasovasostomy with intra-operative local MMC. The control group (n=21) underwent standard vasovasostomy.
Mean sperm count in MMC group was significantly higher than the controls. The sperm count of more than 20 million/ml was respectively 53% and 14% in MMC and control groups. In a subgroup where the interval between vasectomy and reversal was 5-10 years, post-reversal azoospermia was absent in MMC group, but 50% of the controls were still azoospermic. In addition, 80% of MMC group had more than 20 million/ml sperms, but all of the controls had less than 20 million/ml sperms. No significant complication was seen.
Intra-operative local MMC in vasovasostomy can be regarded as a safe and efficient technique which has several advantages including lower cost. Increase of sperm count is the main effect of local MMC application that is more prominent when the interval between vasectomy and reversal is 5-10 years (Registration number: IRCT2015092324166N1).
2%至6%接受输精管切除术的男性最终会寻求输精管复通术，术后晚期狭窄和梗阻相对常见。为找到一种改善输精管吻合术效果的方法，我们术中使用局部丝裂霉素-C（MMC）以预防可能的纤维化和狭窄。
在这项随机临床试验中，44例患者在为期一年的研究期间被随机分为两组，对40例患者的数据进行分析。术后对患者进行6个月的随访。病例组（n = 19）采用术中局部应用MMC的输精管吻合术治疗。对照组（n = 21）接受标准输精管吻合术。
MMC组的平均精子计数显著高于对照组。MMC组和对照组精子计数超过2000万/毫升的比例分别为53%和14%。在输精管切除术与复通术间隔为5至10年的亚组中，MMC组术后无无精子症，但对照组有50%仍为无精子症。此外，MMC组80%的患者精子计数超过2000万/毫升，而对照组所有患者精子计数均低于2000万/毫升。未观察到明显并发症。
输精管吻合术中术中局部应用MMC可被视为一种安全有效的技术，具有包括成本较低在内的多种优势。增加精子计数是局部应用MMC的主要效果，在输精管切除术与复通术间隔为5至10年时更为显著（注册号：IRCT2015092324166N1）。
