Laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction

Masahiro Uchida; Shuichi Iida; Kazuhiko Hoshi; Kosuke Kojo; Haruki Tsuchiya; Kazumitsu Yamasaki; Jun Miyazaki; Teruaki Iwamoto

doi:10.1002/iju5.12150

Laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction

IJU Case Rep. 2020 Feb 24;3(2):72-75. doi: 10.1002/iju5.12150. eCollection 2020 Mar.

Authors

Masahiro Uchida^{1

2}, Shuichi Iida^{3

4}, Kazuhiko Hoshi³, Kosuke Kojo^{1

5}, Haruki Tsuchiya¹, Kazumitsu Yamasaki^{1

3}, Jun Miyazaki^{1

6}, Teruaki Iwamoto^{1

7}

Affiliations

¹ Reproduction Center International University of Health and Welfare Hospital Nasushiobara Japan.
² Department of Urology Tsukuba Gakuen Hospital Tsukuba Japan.
³ Suzuki Memorial Hospital Iwanuma Japan.
⁴ Prefectural Art Museum Mae Ladies Mental Clinic Shizuoka Japan.
⁵ Department of Urology University of Tsukuba Tsukuba Japan.
⁶ Department of Urology School of Medicine International University of Health and Welfare Narita Japan.
⁷ Division of Male Infertility Sanno Hospital Center for Human Reproduction International University of Health and Welfare Tokyo Japan.

Abstract

Introduction: Repair of obstructive azoospermia caused by childhood herniorrhaphy may be difficult. Therefore, intracytoplasmic sperm injection using testicular sperm is performed. However, vasovasostomy combined with laparoscopic surgery is challenging.

Case presentation: A 42-year-old man underwent inguinal hernia repair at age 3. He had normal testicular size, azoospermia, normal hormone levels (follicle-stimulating hormone, luteinizing hormone, and testosterone), absence of Y chromosome micro deletion, and karyotype:46XY, t(1:21)(p34.1:q22.3). He was diagnosed with obstructive azoospermia. Repeated intracytoplasmic sperm injections using testicular sperm resulted in miscarriages. Vasovasostomy combined with laparoscopic surgery was subsequently performed. Postoperative semen analysis result was almost normal. After intracytoplasmic sperm injection of ejaculated sperm, his wife got pregnant.

Conclusion: Even if patients have chromosomal abnormalities, performing microsurgical re-anastomosis first is recommended. To our knowledge, this is the first case of a laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction in Japan.

Keywords: herniorrhaphy; laparoscopy; vas deferens; vasovasostomy.

Publication types

Case Reports