Infertility: Management: Difference between revisions
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*#*Done with a high-suction glass syringe and a 23-gauge needle or angiocath sheath | *#*Done with a high-suction glass syringe and a 23-gauge needle or angiocath sheath | ||
*#*'''Least invasive and least painful procedure but usually yields few tubules with poorly preserved architecture and often requires 10 to 20 passes to obtain an adequate yield''' | *#*'''Least invasive and least painful procedure but usually yields few tubules with poorly preserved architecture and often requires 10 to 20 passes to obtain an adequate yield''' | ||
* '''Adverse Events'''**'''Most common complication is hematoma''' | * '''Adverse Events''' | ||
**'''Most common complication is hematoma''' | |||
====Approach==== | ====Approach==== | ||
*'''<span style="color:#ff0000">If azoospermia''' | *'''<span style="color:#ff0000">If azoospermia''' | ||
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***'''If the fluid expressed from the vas is found to be thick, white, water insoluble, and toothpaste-like''' in quality, microscope examination rarely reveals sperm. Under these circumstances, '''the tunica vaginalis is opened and the epididymis inspected. If clear evidence of obstruction is found—that is, an epididymal sperm granuloma with dilated tubules above and collapsed tubules below—vasoepididymostomy is performed.''' When in doubt, or if not very experienced with vasoepididymostomy, vasovasostomy should be performed. | ***'''If the fluid expressed from the vas is found to be thick, white, water insoluble, and toothpaste-like''' in quality, microscope examination rarely reveals sperm. Under these circumstances, '''the tunica vaginalis is opened and the epididymis inspected. If clear evidence of obstruction is found—that is, an epididymal sperm granuloma with dilated tubules above and collapsed tubules below—vasoepididymostomy is performed.''' When in doubt, or if not very experienced with vasoepididymostomy, vasovasostomy should be performed. | ||
****Vasoepididymostomy should only be performed on an epididymal tubule containing sperm | ****Vasoepididymostomy should only be performed on an epididymal tubule containing sperm | ||
**''' | **'''Relationship between gross appearance of vasal fluid and microscopic findings''' | ||
***'''UrologySchool.com Summary''' | ***'''UrologySchool.com Summary''' | ||
****'''Clear/thin, water vasal fluid: vasovasostomy''' | ****'''Clear/thin, water vasal fluid: vasovasostomy''' | ||
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*'''<span style="color:#ff0000">Stimulation can be done with penile vibratory devices or electroejaculation''' | *'''<span style="color:#ff0000">Stimulation can be done with penile vibratory devices or electroejaculation''' | ||
**'''<span style="color:#ff0000">Approach depends on level of spinal cord | **'''<span style="color:#ff0000">Approach depends on level of spinal cord lesion[https://www.ncbi.nlm.nih.gov/pubmed/12406364 §]''' | ||
***'''<span style="color:#ff0000">If lesion above T10, ejaculatory reflex arc will be intact so can stimulate with penile vibratory devices''' | ***'''<span style="color:#ff0000">If lesion above T10, ejaculatory reflex arc will be intact so can stimulate with penile vibratory devices''' | ||
***'''<span style="color:#ff0000">If lesion T10 or below, consider electroejaculation''' | ***'''<span style="color:#ff0000">If lesion T10 or below, consider electroejaculation''' | ||
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**'''<span style="color:#ff0000">Ejaculatory stimulation for men with spinal cord injuries may result in autonomic dysreflexia''' | **'''<span style="color:#ff0000">Ejaculatory stimulation for men with spinal cord injuries may result in autonomic dysreflexia''' | ||
***'''<span style="color:#ff0000">Autonomic dysreflexia''' | ***'''<span style="color:#ff0000">Autonomic dysreflexia''' | ||
****'''See 2019 CUA NLUTD Guideline Notes''' | ****'''See [[CUA: Neurogenic Lower Urinary Tract Dysfunction (2019)|2019 CUA NLUTD Guideline Notes]]''' | ||
****'''An uninhibited sympathetic reflex accompanied by headache, diaphoresis, hypertension, bradycardia, and diaphoresis''' | ****'''An uninhibited sympathetic reflex accompanied by headache, diaphoresis, hypertension, bradycardia, and diaphoresis''' | ||
****'''More common with spinal cord injury at a level of T6 or above''' | ****'''More common with spinal cord injury at a level of T6 or above''' | ||