Surgical outcomes in male reconstructive urology: The Qatar experience

Abstract

Background: Obstructive azoospermia (OA) is a prevalent cause of male infertility in Qatar and globally, with vasectomy reversal (VV) and vasoepididy-mostomy (VE) being the primary surgical treatments. While microsurgical techniques have advanced, data from the Middle East remain limited, influenced by the region's distinct demographic and cultural factors. This study aimed to evaluate the outcomes of microsurgical VV and VE performed for OA in a tertiary center in the Middle East, with a focus on success rates, influencing factors, and the unique regional characteristics of OA.

Methods: A retrospective cohort study analyzed 105 patients with OA undergoing VV or VE over a period of 10 years. Data on demographics, clinical variables, surgical findings, and postoperative outcomes were assessed. Success was defined as sperm presence in semen within 3-6 months post-surgery.

Results: The overall success rate for VV was 85.7%, with similar rates across bilateral and unilateral procedures. VE success was 50%, with bilateral intussusception technique yielding superior outcomes (71.9%). Factors predicting success included shorter obstructive interval for VV and bilateral reconstruction for VE.

Conclusion: Microsurgical VV remains a reliable first-line treatment for OA, achieving high success rates consistent with international benchmarks. VE presents greater variability in outcomes, highlighting the complexity of managing epididymal obstruction and the importance of advanced surgical techniques like intussusception. The distinct etiological patterns observed in the Middle East emphasize the need for tailored approaches to diagnosis, surgical planning, and patient counseling.

Keywords

obstructive azoospermia / predictors of success / vasoepididymostomy / vasovasostomy

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