Surgical Treatment of Male Infertility

Abstract

Male infertility may occur due to obstructive and non-obstructive reasons, and some pathologies may be corrected with surgical and medical treatment. Such treatment may increase the possibility of spontaneous pregnancy, the success of assisted reproductive technology, and also testicular sperm retrieval rate. This review will focus on surgical treatment alternatives in infertile males. Although treatment options for varicocele in infertile men include open surgical, radiologic, and laparoscopic approaches; microsurgical varicocele repair has the highest improvement in postoperative sperm parameters with lower complication rates. Recent advances in microsurgical anastomosis techniques have increased the patency rate for proximal epididymal obstruction. Although treatment options for distal ejaculatory duct obstruction include endoscopic resection, balloon dilatation, and laser incision/excision, transurethral resection of the ejaculatory duct (TURED), is still the primary gold standard treatment of distal ejaculatory duct obstruction. The testicular sperm retrieval rate has increased with the management of correctable pathologies in men with non-obstructive azoospermia. In case of treatment failure of correctable or uncorrectable pathologies of male factor infertility, surgical sperm obtained from the urogenital tract may necessary for assisted reproductive technology. Surgical success rates for male infertility and the success of surgical sperm obtained procedures have increased dramatically over the last decades attributable to the development of microsurgical techniques and endoscopic equipment, instrumentation, and techniques.

Keywords

• Male infertility
• varicocele
• obstructive azoospermia
• surgical treatment

Erkek İnfertilitesinin Cerrahi Tedavisi

Abstract

Erkek infertilitesi obstrüktif ve obstrüktif olmayan sebeplerle oluşabilir ve bunların bazıları cerrahi ve medikal tedavi ile düzeltilebilir. Bu tedavi yöntemleri çiftlerde spontan gebelik şansını artırabildiği gibi bu tedaviler ile üremeye yardımcı tedavi yöntemleri başarısı ve testiküler sperm bulma şansı artabilir. Bu derlemede infertil erkeklerde cerrahi tedavi yöntemleri irdelenecektir. Varikoselli infertil erkeklerde tedavi opsiyonları açık ve laparoskopik cerrahi ve radyolojik tedavi olmakla birlikte, mikrocerrahi varikoselektomi postoperatif sperm parametrelerinde en yüksek artış oranı ve en düşük komplikasyon oranlarına sahiptir. Proksimal epididimal obstrüksiyonların cerrahi tedavisinde mikrocerrahi anastomoz yöntemlerindeki ilerlemeler kanalın açılma başarısını artırmaktadır. Distal ejakülatör kanal tıkanıklığının cerrahi tedavisinde endoskopik rezeksiyon, balon dilatasyon, lazerle insizyon/eksizyon yöntemleri bulunmakla beraber, transüretral ejakülatör kanal rezeksiyonu (transurethral resection of the ejaculatory duct, TURED) hala altın standart tedavi yöntemidir. Nonobstrüktif azospermide düzeltilebilir patolojilerin giderilmesiyle testiküler sperm elde etme oranlarında artış gösterilmiştir. Düzeltilebilir veya düzeltilemez patolojilere bağlı erkek infertilitesinde tedavi başarısızlığı durumunda yardımcı üreme teknolojisi için ürogenital sistemden cerrahi olarak sperm elde etmek gerekli olabilir. Erkek infertilitesi cerrahi tedavilerinin başarı oranları ve cerrahi olarak sperm elde etme başarı oranları, mikro cerrahi tekniklerinin, endoskopik ekipman, enstrümantasyon ve tekniklerin gelişmesine bağlı olarak son dekatlarda çarpıcı bir şekilde artmıştır.

Keywords

• Erkek infertilitesi
• varikosel
• obstrüktif azospermi
• cerrahi tedavi

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