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ABSTRACT: Following microsurgical vasoepididymostomy as many as 85% of men have sperm in the ejaculate, yet only 30 to 50% will spontaneously father children. We examined the possibility that there may be concomitant abnormalities in the prostate and seminal vesicle, which may be associated with low pregnancy rates.
Transrectal ultrasound was performed in azoospermic men with suspected epididymal obstruction, excluding those who had undergone vasectomy, to identify abnormalities of the seminal vesicles and ejaculatory ducts. Microsurgical vasoepididymostomy was attempted in all men.
Transrectal ultrasound revealed ejaculatory duct dilatation in 13 of 40 men (33%), although only 3 had accompanying seminal vesicle dilatation. Two men had atrophic seminal vesicles with normal ejaculatory ducts. At surgery 8 of 40 patients (20%) were deemed to have irreparable conditions. For the 27 men followed at least 6 months postoperatively patency and pregnancy rates were 75 and 22%, respectively. Mean sperm counts plus or minus standard deviation were significantly higher in men without compared to those with seminal vesicle or ejaculatory duct abnormalities (43 +/- 68 versus 5.7 +/- 6.9 x 10(6) sperm per ml., respectively), and so was the percentage of motile sperm (30 +/- 16% versus 1.2 +/- 2.2%, respectively). Pregnancy rates were also higher in men without (6 of 19, 32%) than with (0 of 8, 0%) seminal vesicle or ejaculatory duct abnormalities.
Transrectal ultrasound detected abnormalities of the seminal vesicles and ejaculatory ducts are common in men with suspected epididymal obstruction. These abnormalities are associated with a poor outcome for vasoepididymostomy. We recommend that all men with suspected epididymal obstruction undergo transrectal ultrasound before any attempted reconstruction.
The Journal of Urology 11/1998; 160(4):1410-2. · 3.75 Impact Factor
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K Jarvi,
S McCallum,
J Zielenski,
P Durie,
E Tullis,
M Wilchanski, M Margolis,
M Asch,
B Ginzburg,
S Martin,
M B Buckspan,
L C Tsui
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ABSTRACT: To determine if the types of reproductive tract abnormalities linked to absence of the vas deferens varies with the cystic fibrosis transmembrane conductance regulator (CFTR) genotype.
Prospective data gathering.
University infertility clinic.
Forty-six infertile men with absence of the scrotal vas deferens and no signs of cystic fibrosis.
All had blood taken for CFTR gene analysis, 33 had scrotal ultrasounds, and 25 had transrectal ultrasounds.
The frequency of testicular, seminal vesicle, and ampullae of the vas deferens malformations was compared between subgroups of men with two, one, or no CFTR gene mutations.
None (0 of 21) of the men with at least one CFTR gene mutations had normal ampullae of the vas or seminal vesicles bilaterally. Two (50%) of 4 men with no CFTR gene mutations had normal ampullae of the vas deferens bilaterally, and 50% had normal bilateral seminal vesicles (statistically significantly different). There was no correlation between testicular malformations and CFTR genotype.
This study indicates that the severity of the malformations in the testis is unrelated to the CFTR genotype, whereas the frequency and severity of wolffian duct malformations are related directly to the CFTR genotype.
Fertility and Sterility 11/1998; 70(4):724-8. · 3.56 Impact Factor
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ABSTRACT: Hepatic cryosurgery has been shown to be a safe technique that may be well suited to a laparoscopic approach.
The technical feasibility and safety of laparoscopic cryosurgery was explored first in a pig model. Thereafter we performed the first successful case of laparoscopic hepatic cryosurgery at our institution.
In the animal model, we found that it is possible to safely identify, target, and cryoablate specific lesions in the liver. Temperature in the peritoneal cavity remained above 35 degrees C, and pathologic examination of the abdominal wall around the cryoprobe site revealed no damage. We also successfully treated a 62-year-old man with a metastatic colorectal carcinoma deep in the right lobe of the liver with laparoscopic cryosurgery using a transpleural approach.
We conclude that laparoscopic cryosurgery is feasible for lesions anywhere in the liver. For lesions high on the dome of the liver, a transpleural approach may provide better access.
Surgical Endoscopy 12/1997; 11(11):1115-7. · 4.01 Impact Factor
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ABSTRACT: Background: Hepatic cryosurgery has been shown to be a safe technique that may be well suited to a laparoscopic approach.
Methods: The technical feasibility and safety of laparoscopic cryosurgery was explored first in a pig model. Thereafter we performed
the first successful case of laparoscopic hepatic cryosurgery at our institution.
Results: In the animal model, we found that it is possible to safely identify, target, and cryoablate specific lesions in the liver.
Temperature in the peritoneal cavity remained above 35°C, and pathologic examination of the abdominal wall around the cryoprobe
site revealed no damage. We also successfully treated a 62-year-old man with a metastatic colorectal carcinoma deep in the
right lobe of the liver with laparoscopic cryosurgery using a transpleural approach.
Conclusion: We conclude that laparoscopic cryosurgery is feasible for lesions anywhere in the liver. For lesions high on the dome of
the liver, a transpleural approach may provide better access.
Surgical Endoscopy 01/1997; 11(11):1115-1117. · 4.01 Impact Factor
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ABSTRACT: A prospective study was undertaken to determine whether the use of laparoscopy plus laparoscopic ultrasound examination can avoid unnecessary laparotomy, without missing potentially curable disease, in patients scheduled for curative liver surgery. Thirty-one consecutive patients who underwent surgery for planned curative liver surgery were prospectively evaluated by means of both laparoscopy plus laparoscopic ultrasound and laparotomy with intraoperative ultrasound. Laparoscopic ultrasound examination of the liver could not be performed in two patients, and in two other patients only partial examinations were possible because of dense adhesions. All patients underwent laparotomy with intraoperative ultrasound. A total of 50 malignant lesions were identified by laparoscopic ultrasound. All of these lesions were confirmed to be malignant at laparotomy with intraoperative ultrasound, that is, there were no false positive results. An additional four malignant lesions in four patients were not seen at laparoscopic ultrasound examination but were identified at laparotomy with intraoperative ultrasound (sensitivity 93%, specificity 100%, positive predictive value 100%, negative predictive value 85%). Based on the laparoscopic ultrasound findings, nontherapeutic laparotomy could have been avoided in 10% of our patients. Laparoscopy with laparoscopic ultrasound is a promising technology that may allow some patients to avoid a nontherapeutic laparotomy without significant risk of missing potentially curable disease.
Journal of Gastrointestinal Surgery 1(2):146-50; 150-1. · 2.83 Impact Factor
