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Asymptomatic postpubertal male with equally sized normal testicles with palpable left varicocele

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Asian Journal of Andrology 2016年第2期18卷 310-310页

作者： A Scott Polackwich Edmund Sabanegh Jr male infertility and microsurgery Department of Urology Glickman Urological and Kidney Institute Cleveland Clinic Foundation 9500 Euclid Avenue QIOCleveland OH 44195 USA

Varicoceles are a common finding in the general public. The incidence appears to increase later in life with a contemporary study finding an increase in incidence of 10% per decade of life） While common in the general population, they are even more common among those presenting for a fertility evaluation, as high as 39% in some series and are often initially diagnosed during such examinations） Others present without symptoms or fertility issues and are found incidentally on a physical exam by a general practitioner.

关键词： MEN

Microdissection testicular sperm extraction： an update

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Asian Journal of Andrology 2013年第1期15卷 35-39页

作者： Ali A Dabaja Peter N Schlegel Department of Urology Male Reproductive Medicine Weill Cornell Medical College New York NY 10065 USA

Patients with non-obstructive azoospermia （NOA） were once considered to be infertile with few treatment options due to the absence of sperm in the ejaculate. In the last two decades, the advent of intracytoplasmic sperm injection （ICSI）, and the application of various testicular sperm retrieval techniques, including fine needle aspiration （FNA）, conventional testicular sperm extraction （TESE） and microdissection testicular sperm extraction （micro-TESE） have revolutionized treatment in this group of men. Because most men with NOA will have isolated regions of spermatogenesis within the testis, studies have illustrated that sperm can be retrieved in most men with NOA, including Klinefelter＇s syndrome （KS）, prior history of chemotherapy and cryptorchidism. Micro-TESE, when compared with conventional TESE has a higher sperm retrieval rate （SRR） with fewer postoperative complications and negative effects on testicular function. In this article, we will compare the efficacy of the different procedures of sperm extraction, discuss the medical treatment and the role of testosterone optimization in men with NOA and describe the micro-TESE surgical technique. Furthermore, we will update our overall experience to allow counseling on the prognosis of sperm retrieval for the specific subsets of NOA.

关键词： azoospermia genetics male infertility microsurgery non-obstructive azoospermia sperm retrieval testicular sperm extraction

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

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Asian Journal of Andrology 2016年第1期18卷 154-156页

作者： Yan Zhang Xiao Wu Xiao-Jian Yang Hao Zhang Bin Zhang Department of infertility and Sexual Medicine The Third Affiliated Hospital Sun Yat-sen University Guangzhou 510630 China

Dear Editor, Vasoepididymostomy plays an important role in treating epididymal obstructive azoospermia and this procedure is becoming more popular in the developing countries Hcwever, we believe its effectiveness and safety should also be considered. Varicocelectomy is very common in treating male infertility due to palpable varicocele and decreased semen quality, as well as reduzing testicular pain？ Therefore the question remains is whether simultaneous/asynchronous microsurgery of vasoepididymostomy and vai icocele ligation safe？

关键词： SUBINGUINAL VARICOCELECTOMY

A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy

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Asian Journal of Andrology 2018年第6期20卷 576-580页

作者： Kun-Long Lyu Jin-Tao Zhuang Philip S Li Yong Gao Liang Zhao Ya-Dong Zhang Ming-Kuan Zhou Jing-Wei Yu Xin Feng Xiang-Zhou Sun Chun-Hua Deng Xiang-An Tu Department of Urology and Andrology The First Affiliated Hospital of Sun Yat-Sen University Guangzhou 510000 China Department of Urology and Andrology The First Affiliated Hospital of Zhengzheu University Zhengzhou 450000 China Center for male Reproductive Medicine and microsurgery Department of Urology Weill Cornell Medicine of Cornell University New York NY 10065 USA Center for Reproductive Medicine Guangdong Provincial Key Laboratory of Reproductive Medicine The First Affiliated Hospital of Sun Yat-Sen University Guangzhou 510000 China

Microsurgical longitudinal intussusception vasoepididymostomy （LIVE） has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine （85.5%, 59/69） men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis （〉10 000 sperm/ml） in 83.1% （49159） of men. The natural pregnancy rate was 40.7% （24/59） by the end of the study, with 87.5% （21124） of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.

关键词： azoospermia infertility microsurgery vasoepididymostomy

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男性不育的遗传学评估

中华男科学杂志 2014年第2期20卷 99-105页

作者： Matthew WOSNITZER 赵福军李石华 Center for male Reproductive Medicine and microsurgery Department of UrologyCornell Institute for Reproductive MedicineWeill Cornell Medical CollegeCornell UniversityThe New York Presbyterian Hospital Department of Urology The First People's Hospital of Shanghai Jiaotong University

无精子症或严重少精子症男性(<5×10 6/ml)在接受治疗之前应通过遗传学检测确定其不育的真正原因。正确区分梗阻性无精子症(obstructive azoospermia,OA)与非梗阻性无精子症(non-obstructive azoospermia,NOA)至关重要,因为相比于NOA(... 详细信息

无精子症或严重少精子症男性(<5×10 6/ml)在接受治疗之前应通过遗传学检测确定其不育的真正原因。正确区分梗阻性无精子症(obstructive azoospermia,OA)与非梗阻性无精子症(non-obstructive azoospermia,NOA)至关重要,因为相比于NOA(睾丸体积小、质地柔软、FSH水平升高),OA(正常的睾丸功能、睾丸体积以及FSH水平)的遗传学检测有所不同。在NOA患者人群中,病史回顾、体格检查和实验室检测对于遗传学检测方法的选择是必须的,尤其针对原发性睾丸衰竭或先天性低促性腺激素型性腺功能低下症的NOA患者。遗传学检测包括由于先天性输精管缺如所致OA的囊性纤维化跨膜传导调节因子的检测,和针对严重少精子症或NOA患者的染色体核型分析、Y染色体微缺失等其他特殊检测方法。这些遗传学检测能够帮助判定哪些患者适合药物和/或手术治疗。最新的遗传学分析技术将有助于男性不育的诊断和掌控。

关键词：男性不育少精子症无精子症梗阻性无精子症非梗阻性无精子症遗传学检测

如何成为合格的泌尿男科显微外科医生：美国康奈尔大学威尔医学院的学习经历

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中华男科学杂志 2014年第7期20卷 595-604页

作者：赵福军彭靖李石华 Richard Lee Marc Goldstein 上海交通大学附属第一人民医院泌尿外科上海200080 北京大学第一医院男科中心北京100034 Center for male Reproductive Medicine and microsurgery Department of UrologyWeill Cornell Medical College of Cornell UniversityNew YorkNY 10065 USA

泌尿男科显微外科是泌尿外科中发展最快的的亚专业。随着男科患者数量增多,新型医疗技术的发展,最近20年男性显微外科的飞速发展,使众多男性不育患者得到有效治疗。男科的发展备受关注,对男科医师的需求越来越急迫。国内泌尿男科显微外... 详细信息

泌尿男科显微外科是泌尿外科中发展最快的的亚专业。随着男科患者数量增多,新型医疗技术的发展,最近20年男性显微外科的飞速发展,使众多男性不育患者得到有效治疗。男科的发展备受关注,对男科医师的需求越来越急迫。国内泌尿男科显微外科虽然取得一定的成绩,但有别于普通泌尿外科的培养学习曲线,如何成为合格的、规范的专业男科显微外科医师不是简单的事情,目前国内没有现成的培养模式可循。美国康奈尔大学男性生殖医学和显微外科中心建立并规范专科泌尿/男科医生培训项目,男性不育显微外科是对体力、脑力和技术的挑战,首先必须在显微外科实验室进行正规培训,为今后临床工作奠定坚实基础。通过作者在康奈尔大学显微男科培训中心的学习经历,将实验室各项系统的、专业的显微外科培训中细节和基本原则,从专业定位、知识储备、技能训练、临床积累等方面进行阐述,希望为国内培养合格的男科显微外科医师提供正确的思路和方法。

关键词：男性不育显微外科外科培训学习曲线

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显微外科技术治疗梗阻性无精子症的新进展

中华男科学杂志 2004年第9期10卷 643-650页

作者： Philip S. Li Marc Goldstein Center for male Reproductive Medicine and microsurgery Cornell Institute for Reproductive Medicine & Department of Urology Weill Medical College of Cornell University The New York Presbyterian University Hospital for Columbia and Cornell New York NY 10021 USACenter for Biomedical ResearchPopulation Council New York NY 10021 USACenter for Male Reproductive Medicine and MicrosurgeryCornell Institute for Reproductive Medicine & Department of Urology Weill Medical College of Cornell University The New York Presbyterian University Hospital for Columbia and Cornell New York NY 10021 USACenter for Biomedical ResearchPopulation Council New York NY 10021 USA

显微外科技术在最近 5～ 10年的生殖医学发展中扮演了重要角色。显微外科的睾丸取精技术和附睾取精技术 ,与体外受精和卵细胞内单精子注射技术的结合 ,使得过去一直被认为是难以治疗的因生精功能障碍所致的非梗阻性无精子症的治疗成为... 详细信息

显微外科技术在最近 5～ 10年的生殖医学发展中扮演了重要角色。显微外科的睾丸取精技术和附睾取精技术 ,与体外受精和卵细胞内单精子注射技术的结合 ,使得过去一直被认为是难以治疗的因生精功能障碍所致的非梗阻性无精子症的治疗成为现实。与此同时 ,显微外科输精管吻合和输精管附睾吻合的技术革命使治疗梗阻性无精子症的效果显著地改善 ,成为治疗梗阻性无精子症的首选方法。本文着重介绍了显微外科输精管吻合术、输精管附睾吻合术、手术指征与手术成功的要素 ,预测了未来的发展方向 ,讨论了显微外科技术的优势 ,强调了显微外科培训对泌尿外科医生治疗男性不育患者的重要意义。

关键词：显微外科输精管吻合输精管附睾吻合梗阻性无精子症:显微外科培训

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梗阻性无精子症显微外科治疗进展和展望

中华男科学杂志 2018年第7期24卷 579-588页

作者：李朋李铮李石华上海交通大学附属第一人民医院泌尿外科医学中心男科上海交通大学泌尿外科研究所男性健康评估中心上海市生殖医学重点实验室上海200080 Center for male Reproductive Medicine and microsurgery Department of UrologyCornell Institute for Reproductive MedicineWeill Comell Medicine of Comell UniversityNew York Presbyterian University Hospital for Columbia and CornellNew YorkNY 10065USA Center for Biomedical Research Population CouncilNew YorkNY10021USA

近年来,随着辅助生殖技术,尤其是男性不育显微外科技术的迅猛发展,部分过去无法自然生育的梗阻性无精子症患者可重建精道,进而获得自然妊娠的机会。本文着重介绍梗阻性无精子症的精道重建手术的最新进展,包括腹腔镜技术、机器人技术等... 详细信息

近年来,随着辅助生殖技术,尤其是男性不育显微外科技术的迅猛发展,部分过去无法自然生育的梗阻性无精子症患者可重建精道,进而获得自然妊娠的机会。本文着重介绍梗阻性无精子症的精道重建手术的最新进展,包括腹腔镜技术、机器人技术等新技术在重建精道方面的具体应用;同时分析了显微外科附睾精子抽吸术及精子保存、可吸收缝线显微外科吻合技术和生物缝合带包裹输精管吻合口的显微外科输精管吻合术在梗阻性无精子症中的应用前景等。

关键词：梗阻性无精子症显微外科输精管吻合术输精管附睾吻合术

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中国男性不育显微外科15年发展历程及展望

中华男科学杂志 2014年第7期20卷 586-594页

作者：彭靖李铮涂响安田龙张炎洪锴王翔袁亦铭赵连明平萍周立新刘毅东毛向明赵福军陈向锋董强孙中义周铁刘智勇孙祥宙姜涛李石华北京大学第一医院男科中心北京100034 上海交通大学医学院附属仁济医院泌尿外科上海200127 中山大学附属第一医院泌尿外科广东广州510700 首都医科大学附属北京朝阳医院泌尿外科北京100020 中山大学附属第三医院泌尿外科广东广州510630 北京大学第三医院泌尿外科北京100191 复旦大学华山医院泌尿外科上海200040 南方医科大学南方医院泌尿外科广东广州510515 上海交通大学附属第一人民医院泌尿外科上海200080 四川大学华西医院泌尿外科四川成都610041 第三军医大学大坪医院泌尿外科重庆400042 第二军医大学长海医院泌尿外科上海200433 大连医科大学第一医院泌尿外科辽宁大连116011 Center for male Reproductive Medicine and microsurgery Weill Cornell Medical College of Cornell University

男性不育症是泌尿男科常见而复杂的疾病,长期以来缺少有效的外科治疗方法。随着男性不育显微外科和辅助生殖技术的出现,男性不育症的治疗得到飞速发展。美国康奈尔大学医学院(Weill Cornell Medical College of Cornell University)引... 详细信息

男性不育症是泌尿男科常见而复杂的疾病,长期以来缺少有效的外科治疗方法。随着男性不育显微外科和辅助生殖技术的出现,男性不育症的治疗得到飞速发展。美国康奈尔大学医学院(Weill Cornell Medical College of Cornell University)引领了男性不育显微外科发展的方向和进程。男性不育显微外科从系统地引入中国到今天被大家普遍接受,经历了漫长的过程。男性不育显微外科在中国近15年经历了引入、兴起和繁荣3个阶段,目前中国多家医院相继开展男科显微外科手术,初步建立了男性不育显微外科治疗体系。然而,在中国,男性不育显微外科医生仍然缺乏严格规范的显微外科技术培训,缺乏统一的男性不育评估标准和手术效果的评估,缺乏详细的患者术后随访数据。本综述回顾了男性不育显微外科在中国的发展历程,肯定了男性不育显微外科在中国的发展,也指出了不足,建议今后在显微外科医生的正规培训、建立标准化的男性不育显微手术前后评估和随访流程、在国内开展大规模男性不育显微手术协作临床科学研究等方面加强工作,促进男性不育显微外科在中国发展。

关键词：男性不育显微外科显微外科培训历史展望