Gurnani Nishant, Goel Ritesh, Kumar Manoj, Dada Rima, Kumar Rajeev
Department of Urology, AIIMS, New Delhi, India.
Department of Anatomy, AIIMS, New Delhi, India.
Eur Urol Open Sci. 2023 Apr 29;52:30-35. doi: 10.1016/j.euros.2023.03.015. eCollection 2023 Jun.
Men with idiopathic obstructive azoospermia (OA) are candidates for surgical reconstruction with a vasoepididymal anastomosis (VEA) performed on one or both testis. There are no randomised trials comparing the success of unilateral versus bilateral VEA.
We conducted a randomised trial to compare the two surgical options.
Between April 2017 and March 2022, men with infertility due to idiopathic OA were randomised to a unilateral (group 1) or bilateral (group 2) VEA in an ethics committee-approved clinical trial, registered with the Clinical Trials Registry.
The primary outcome was successful surgery, defined as appearance of sperm in the ejaculate, evaluated at 3 mo intervals after surgery. Additional outcomes were pregnancy rates and complications between the two groups. Men with successful surgery were compared with those without patency to identify the predictors of success.
Fifty-four men fulfilled the criteria and 52 who completed follow-up were included in the analysis. The overall patency rate was 36.5% (19/52 individuals). This was higher in men with bilateral surgery (12/26 patients, 46%) than in those with unilateral surgery (7/26 patients, 27%) but was not statistically significant ( = 0.1). The overall pregnancy rate with ejaculated sperm was significantly higher in the bilateral surgery group (4 vs 0, = 0.037), while the spontaneous conception rate was higher but not statistically significant (3 vs 0, = 0.074). The complication rates in the two groups were similar ( = 0.7), and all complications were Clavien-Dindo grade 1. Although bilateral surgery and presence of sperm in epididymal fluid were higher in men with patency, these were not statistically significant.
A bilateral VEA was associated with higher patency and spontaneous pregnancy rates than unilateral surgery, but the results were not statistically significant. However, the overall pregnancy rate with ejaculated sperm, spontaneous and assisted, was significantly higher in the bilateral surgery group.
In this study, we compared between unilateral and bilateral reconstructive surgery in azoospermic men and found better overall success with bilateral surgery. However, these results were not statistically significant.
患有特发性梗阻性无精子症（OA）的男性是对一侧或双侧睾丸进行输精管附睾吻合术（VEA）手术重建的候选者。尚无随机试验比较单侧与双侧VEA的成功率。
我们进行了一项随机试验以比较这两种手术方案。
设计、地点和参与者：在2017年4月至2022年3月期间，因特发性OA导致不育的男性在一项经伦理委员会批准并在临床试验注册中心注册的临床试验中被随机分为单侧（第1组）或双侧（第2组）VEA。
主要结局是手术成功，定义为射精中出现精子，在术后每隔3个月进行评估。其他结局是两组之间的妊娠率和并发症。将手术成功的男性与未通畅的男性进行比较，以确定成功的预测因素。
54名男性符合标准，52名完成随访的男性纳入分析。总体通畅率为36.5%（19/52人）。双侧手术的男性（12/26例患者，46%）高于单侧手术的男性（7/26例患者，27%），但差异无统计学意义（P = 0.1）。双侧手术组射精精子的总体妊娠率显著更高（4例对0例，P = 0.037），而自然受孕率更高但差异无统计学意义（3例对0例，P = 0.074）。两组的并发症发生率相似（P = 0.7），所有并发症均为Clavien-Dindo 1级。虽然通畅的男性中双侧手术和附睾液中有精子的比例更高，但差异无统计学意义。
双侧VEA与单侧手术相比，通畅率和自然妊娠率更高，但结果无统计学意义。然而，双侧手术组射精精子的总体妊娠率，包括自然妊娠和辅助妊娠，显著更高。
在本研究中，我们比较了无精子症男性的单侧和双侧重建手术，发现双侧手术总体成功率更高。然而，这些结果无统计学意义。
