Division of Urology, Virginia Commonwealth University.
Division of Urology, Richmond VA Medical Center, Richmond, Virginia, USA.
Curr Opin Urol. 2021 Jan;31(1):43-48. doi: 10.1097/MOU.0000000000000828.
The aim of this review is to provide an overview of surgical treatment options for male infertility including varicocelectomy, treatment of ejaculatory duct obstruction, vasovasostomy, and sperm extraction, and to review recent advances in techniques and technologies that may improve operative outcomes.
Microscopic subinguinal varicocelectomy has been shown to have the highest success rates with lowest rates of complications, and may be facilitated by the use of Doppler, indocyanine green angiography, and the 4K3D operating video microscope. The standard treatment for ejaculatory duct obstruction by transurethral resection of the ejaculatory ducts has changed little over time, but vesiculoscopy may allow for temporary dilation of an obstruction to allow for natural conception, while also offering diagnostic capabilities. Use of the robotic platform has gained popularity for vasectomy reversals but controversy remains regarding the cost-effectiveness of this option. Recently, a reinforcing suture technique has been described for vasovasostomy to minimize anastomotic breakdown and reversal failure. Finally, gray-scale and color-enhanced ultrasound may improve ability to predict successful sperm retrieval during extraction procedures.
Though the fundamentals of surgical treatment options for male infertility have changed little with time, technological advancements have contributed to improved surgical outcomes over recent years.
本文旨在介绍男性不育的手术治疗选择，包括精索静脉曲张手术、射精管梗阻治疗、输精管-附睾吻合术和精子提取，并回顾可能改善手术效果的技术和技术的最新进展。
显微镜下经腹股沟精索静脉结扎术显示出最高的成功率和最低的并发症发生率，并且可能通过使用多普勒、吲哚菁绿血管造影和 4K3D 手术视频显微镜来辅助。经尿道射精管切除术是射精管梗阻的标准治疗方法，多年来变化不大，但膀胱镜检查可能允许暂时扩张梗阻以实现自然受孕，同时还具有诊断能力。机器人平台在输精管复通术中越来越受欢迎，但这种选择的成本效益仍存在争议。最近，一种加固缝合技术被描述用于输精管-附睾吻合术，以最小化吻合口破裂和复通失败。最后，灰阶和彩色增强超声可能会提高在提取过程中预测精子成功提取的能力。
尽管男性不育的手术治疗选择随着时间的推移基本保持不变，但近年来技术的进步促进了手术效果的改善。
