(409) A New Surgical Method of Vasoepididymostomy for Epididymal Obstructive Azoospermia to Improve Success Rate

Introduction Two-suture longitudinal intussusception vasoepididymostomy (LIVE) won the first prize of the 2003 National Urology Award at the annual urology conference and has been the preferred surgical method for treating epididymal obstruction globally for 22 years. however, the success rate and anastomotic patency rate of LIVE are not high, we have reason to speculate that the new 2-suture circular intussusception vasoepididymostomy (CIVE) can greatly improve the anastomosis rate and success rate. Objective CIVE involves cutting a circular opening of approximately 0.2mm into the epididymal duct with a diameter of approximately 0.3mm, and then overlapping and anastomosing it with the vas deferens with an inner diameter of approximately 0.3mm. CIVE strives to become the preferred technique for epididymal vasectomy globally. I am striving to include CIVE as a replacement for traditional LIVE surgery in the WHO World Health Organization's "Practice Guidelines for Epididymic Obstruction Surgery". Methods 33 male rats (type: Sprague-Dawley, SD) were randomly divided into control (group I) and experimental groups (groups II and III). After 3 weeks of epididymal obstruction, bilateral vasoepididymostomy was performed. In group II, ①the vas deferens was incised obliquely at a 45°angle. The serosal layer of the vas deferens and the epididymal capsule were fixed with 8-0 suture. ②Two identical 10-0 sutures were sutured from the outside to the inside of the vas deferens at the puncture site. They were threaded parallel through the epididymal duct (Figure 1A). ③Another 10-0 stitches were sutured in the middle of the two stitches (Figure 1B), the knot was tied and pulled, and the epididymal duct was lifted (Figure 2A). The epididymal duct was cut using microscopic scissors and a circular incision was made, known as CIVE. (Figure 2B). ④The leaked epididymal fluid was examined for sperms under a microscope. If no sperm was found, the dilated epididymal duct was searched for sperms from the epididymal tail, body, and to the epididymal head. If sperms were found, the 10-0 suture was continued into the mucosal layer of the vas deferens, as shown in Figure 3. The knots were tied to fix the epididymal duct and vas deferens. The serosal layer of the vas deferens and epididymal capsule was reinforced with approximately six stitches and sutured with 8-0 intermittent circular reinforcement. The incision was then closed. In group III, LIVE was performed. After 3 months, patency was assessed in a blinded manner. Results The rates of functional patency (presence of motile sperm in the vas deferens) were 90.9% and 63.6% in groups II and III, respectively (single-tailed test, P=0.042), and it has statistical differences. Conclusions This surgical technique was first proposed, known as CIVE, Compared with LIVE, CIVE at a 45°oblique incision of the vas deferens provides a larger anastomotic area and has a higher recanalization rate. Disclosure No