Abstract：
OBJECTIVE: To report our experience using fine-needle vasography (FNV) to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia (OA) or cryptozoospermia.
METHODS: We report a multi-institutional case series of patients with suspected complete or partial OA. Patients that were included had azoospermia or cryptozoospermia, presence of palpable vasa, testicles ≥12 mL, and FSH <7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. FNV was performed using a 25-gauge angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR).
RESULTS: A total of 16 patients underwent vasography from 2014 to 2022 with 3 surgeons. Twelve patients presented with azoospermia, and 4 with cryptozoospermia. A total of 7 (44%) men were found to have distal obstruction on FNV. Of the 8 men with prior inguinal hernia repairs, 2 were confirmed to have an obstruction at the level of the inguinal canal. Of the 6 patients with a history of genitourinary infection, 4 had an obstruction at the level of the epididymis (with normal FNV), while 2 had atresia of the vas deferens in the pelvis.
CONCLUSIONS: FNV is an effective, minimally invasive way to identify the site of complete or partial obstruction in patients presenting with suspected OA/cryptozoospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction (EDO) and other causes of blockage.
METHODS: We report a multi-institutional case series of patients with suspected complete or partial OA. Patients that were included had azoospermia or cryptozoospermia, presence of palpable vasa, testicles ≥12 mL, and FSH <7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. FNV was performed using a 25-gauge angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR).
RESULTS: A total of 16 patients underwent vasography from 2014 to 2022 with 3 surgeons. Twelve patients presented with azoospermia, and 4 with cryptozoospermia. A total of 7 (44%) men were found to have distal obstruction on FNV. Of the 8 men with prior inguinal hernia repairs, 2 were confirmed to have an obstruction at the level of the inguinal canal. Of the 6 patients with a history of genitourinary infection, 4 had an obstruction at the level of the epididymis (with normal FNV), while 2 had atresia of the vas deferens in the pelvis.
CONCLUSIONS: FNV is an effective, minimally invasive way to identify the site of complete or partial obstruction in patients presenting with suspected OA/cryptozoospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction (EDO) and other causes of blockage.
摘要：
目的：报告我们使用细针血管造影（FNV）确定阻塞部位的经验，并确定可疑梗阻性无精子症（OA）或隐精子症患者的重建程序的候选资格。
方法：我们报告了一系列多机构的疑似完全或部分OA患者。纳入的患者患有无精子症或隐精子症，有明显的vasa,睾丸≥12毫升，FSH<7.6IU/L所有患者在FNV之前或之时接受睾丸活检以确认精子发生。使用25号血管导管进行FNV，用不透射线的染料在透视下可视化。描述性统计数据报告为中值和四分位数间距(IQR)。
结果：从2014年到2022年，共有16例患者接受了血管造影，其中有3名外科医生。12例患者表现为无精子症，和4位隐精子症。共有7名（44％）男性被发现在FNV上有远端梗阻。在8名既往有腹股沟疝修补术的男性中,2被证实在腹股沟管水平有阻塞。在6例有泌尿生殖系统感染史的患者中，4在附睾水平有阻塞（FNV正常），2名患者在骨盆有输精管闭锁。
结论：FNV是一种有效的，以微创方式识别疑似OA/隐精子症患者的完全或部分梗阻部位。此外，它还可以识别出适合进行附睾血管造口术重建的男性，并有助于区分射精管阻塞（EDO）和其他阻塞原因。
方法：我们报告了一系列多机构的疑似完全或部分OA患者。纳入的患者患有无精子症或隐精子症，有明显的vasa,睾丸≥12毫升，FSH<7.6IU/L所有患者在FNV之前或之时接受睾丸活检以确认精子发生。使用25号血管导管进行FNV，用不透射线的染料在透视下可视化。描述性统计数据报告为中值和四分位数间距(IQR)。
结果：从2014年到2022年，共有16例患者接受了血管造影，其中有3名外科医生。12例患者表现为无精子症，和4位隐精子症。共有7名（44％）男性被发现在FNV上有远端梗阻。在8名既往有腹股沟疝修补术的男性中,2被证实在腹股沟管水平有阻塞。在6例有泌尿生殖系统感染史的患者中，4在附睾水平有阻塞（FNV正常），2名患者在骨盆有输精管闭锁。
结论：FNV是一种有效的，以微创方式识别疑似OA/隐精子症患者的完全或部分梗阻部位。此外，它还可以识别出适合进行附睾血管造口术重建的男性，并有助于区分射精管阻塞（EDO）和其他阻塞原因。
