Vasal vessels preserving microsurgical vasoepididymostomy in cases of previous varicocelectomy: a case report and literature review

vasoepididymostomy, should they elect to receive this procedure. He also required an intraoperative testicular biopsy if it was needed but he refused a biopsy before operation because afraid of the scrotal local anesthesia. The procedure was approved by the Ethics Committee of our hospital, and the informed consent was obtained from the patient. The procedure was performed under a Zeiss operating microscope (Carl Zeiss, Berlin, German) with 4–21 magnification with modification, 6,7 and will be described in detail in the following steps: (1) the right testis was delivered through a 3 cm vertical scrotal incision, and the vas was exposed at the junction of the straight and convoluted portions; (2) the vas deferens was subsequently hemi-transected, by cannulating the abdominal end of the vas with a 24-gauge angiocatheter sheath, which patency was confirmed by injecting diluted methylene blue of distal part of vas; (3) the vasal vessels was then carefully isolated for 2–3 cm and preserved, 2 vertical little branches of vas artery supplying vas were ligated (Figure 1), and the vas was then completely transected and its proximal part to the epididymis ligated; (4) the epididymis was inspected under the microscope with 4–8 magnification, and a 5 mm buttonhole was made in the cauda epididymidis tunica and one dilated tubule was selected; (5) the vas deferens was drawn through an opening in the tunica vaginalis, the vas was then secured with 2 interrupted 9-0 microsutures on the edge of epididymal tunica opening in proximity to the anastomotic site; (6) according to intraoperative configuration between epididymal tubule and vas deference, the needles of two double-armed 10-0 microsutures are placed transversely on the selected epididymal tubule (Figure 2a), and the needles were left in epididymal tubule before the incision was made to avoid the collapse; (7) then a 15°ophthalmic knife was used to incise the tubule transversely between the two needles of the sutures (Figure 2b), the epididymal fluid was aspirated with a 24-gauge angiocatheter connected to a 5 ml syringe. The fluid was examined under light microscopy by the surgeon intraoperatively and many motile sperm were founded; (8) then sutures were placed sequentially in inside-out fashion to achieve 4-point anastomosis (Figure 2c and 2d). Fortunately, the anastomosis was tension free. Similar procedures were performed in the left side, and the anastomosis was also transversed two-suture intussusception vasoepididymostomy at site of cauda epididymidis. Data collected included follow-up time, semen analysis, spouse's …