Institute of Urology, University of Southern California, Los Angeles, California, USA.
Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA.
Andrologia. 2022 Aug;54(7):e14439. doi: 10.1111/and.14439. Epub 2022 May 6.
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
本研究的目的是确定预测精子肉芽肿形成的因素，以及精子肉芽肿的存在和数量对输精管复通术（VR）结果的影响。对单家学术中心前瞻性收集的数据进行了横断面回顾性研究，评估了肉芽肿对 VR 结果的影响。分析了年龄、梗阻间隔、术中输精管液发现、吻合类型、体重指数、吸烟和总活动精子计数（TMC）的影响。2000 年 1 月至 2019 年 8 月期间，共有 1550 名男性接受了 VR 手术。单侧肉芽肿占 23.3%（n=361），双侧肉芽肿占 14.2%（n=220）。单因素分析显示，患者年龄的增加与肉芽肿数量的增加呈负相关（p=0.011）。肉芽肿的存在与术中从输精管残端发现完整和活动精子有关（p=0.001），与血管吻合术有关（p<0.001）。然而，肉芽肿的存在（和数量）与梗阻间隔或最大 TMC 无关。吸烟和体重指数（BMI）与肉芽肿的存在无关。多因素分析显示，肉芽肿数量与 TMC 无关。梗阻间隔和血管吻合术与较高的 TMC 相关，而 BMI 与 TMC 呈负相关。总之，年龄的增加与肉芽肿的形成呈负相关。肉芽肿的存在与术中更有利的液体发现和吻合类型有关，但与 VR 后的 TMC 无关，这表明接受熟练显微手术的有和没有肉芽肿的男性的通畅率相似。较重的男性应该在接受输精管复通术之前鼓励减肥，因为 BMI 的增加与 TMC 的降低有关。
