Filipe Tenorio Lira Neto

Spermatogenesis in humans and its affecting factors.

Spermatogenesis is an extraordinary complex process. The differentiation of spermatogonia into spermatozoa requires the participation of several cell types, hormones, paracrine factors, genes and epigenetic regulators. Recent researches in animals and humans have furthered our understanding of the male gamete differentiation, and led to clinical tools for the better management of male infertility. There is still much to be learned about this intricate process. In this review, the critical steps of human spermatogenesis are discussed together with its main affecting factors.

PD68-04 IMPACT OF CFTR MUTATIONS ON PHENOTYPE AND REPRODUCTIVE OUTCOMES IN MEN WITH CONGENITAL ABSENCE OF THE VAS DEFERENS

RESULTS: A total of 198 men (mean age 35 8 years) were included. Fertilization and pregnancy rates were 44% and 38%, respectively. On univariable analysis, sperm motility and the lack of acrosome defects were associated with higher fertilization and pregnancy rates while an increasing number of total sperm abnormalities was negatively associated with fertilization, but not pregnancy, rates (Table). On MVA, only sperm motility was associated with fertilization rates (p<0.001) while both sperm motility (p1⁄40.004) and the lack of acrosome abnormalities (p1⁄40.018) were associated with pregnancy rates. Female age (mean age 31 5 years) was not associated with fertilization or pregnancy rates on MVA. CONCLUSIONS: This study is the first to assess the relationship between injected testicular sperm characteristics and reproductive outcomes in ICSI. All men with NOA have abnormal sperm morphology and our experience suggests that no specific sperm abnormality, including injection of non-motile sperm, precludes the chance of pregnancy. Further study of sperm characteristics may influence how aggressively surgeons should seek better sperm quality during microTESE procedures. Use of elongating spermatids (blunt-tailed sperm) did not adversely affect the chance of pregnancy despite concerns for lower fertilization with severely blunt-tailed sperm.

V9-08 MALE INFERTILITY MICROSURGERY TRAINING – TRICKS OF THE TRADE

INTRODUCTION AND OBJECTIVES: Gender confirmation surgery is an essential component in the management of gender identity disorder. However, short vaginal length, vaginal stenosis, or complications in the perineal dissection are significant limitations of current techniques in male to female surgery. Here we describe our technique for the robot assisted penile inversion vaginoplasty that addresses these needs. METHODS: The patient is prepped and draped in low lithotomy position. The penis is degloved through a circumcision incision. The neurovascular bundle, urethra and corpora cavernosa are dissected out. A six cm bulbar perineal incision is then made, and the dissection is carried to the bulbar urethra. The dissected urethra, neurovascular bundle, glans and corpora are delivered through this incision. The bilateral corpora are transected at their most proximal limit and overswen. The penile skin is inverted and gently retracted to allow a two cm incision above the neovagina for the neoclitoris. Immediately below this, an incision for the neomeatus is made. The urethra is brought through this incision and sutured to the skin. The remaining urethral tissue is used as an inlay onto the incised dorsal epithelial surface of the penile skin. The robotic portion of the surgery uses 4 port incisions: periumbiical Gelport with two pre-placed robotic trocars, right and left lateral ports, and an assistant port in the upper right abdomen. The dissection is from the posterior prostate, staying above Denonviller’s fascia to reach the endopelvic fascia. Under direct vision, the endopelvics are opened sharply from below and opened to a width of two fingerbreadths. The neovagina is passed into robotic field and pexed to the anterior reflection of the posterior peritoneum. The peritoneal reflection is then closed. The neoclitoris is fashioned from the glans penis and approximated. Labia majora and minora are fashioned with local skin flaps. A foley catheter is left indwelling as well as a vaginal stent. RESULTS: The index case required 7 hours of surgical time with an estimated blood loss of 100 mL. The vaginal length was greater than 15 cm. The patient was discharged home on post-operative day three, with no complications. The patient endorses sensation at the neoclitoris and anterior neovagina, and finds the vaginal depth satisfactory CONCLUSIONS: Our novel method for robot assisted penile inversion vaginoplasty is an important step in optimizing outcomes for our patients. This technique achieves maximal vaginal length in a safe and reproducible manner.

PD07-03 COMPARING VASOEPIDIDYMOSTOMY TECHNIQUE OUTCOMES: LONGITUDINAL INTUSSUSCEPTION VASOEPIDIDYMOSTOMY (LIVE) VERSUS OTHER TECHNIQUES

INTRODUCTION AND OBJECTIVES: Epididymal obstruction is a common cause of obstructive azoospermia. Amongst acquired forms, those secondary to epididymal infection and prolonged vasal obstruction are the most common. Treatment is either microsurgical reconstruction and/or sperm retrieval for in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Microsurgical reconstruction vasoepididymostomy (VE) has been shown to be more cost-effective than sperm retrieval with IVF /ICSI. Since the earliest report of VE in 1903, the technique has undergone continuous improvement, culminating more recently in the development of the longitudinal intussusception microsurgical vasoepididymostomy (LIVE) technique. We compare the patency rates in men that underwent VE using different microsurgical techniques. METHODS: We reviewed a database of 754 microsurgical reconstructive procedures of the male reproductive tract done by a single surgeon (MG). We identified 87 cases with a history of bilateral VE and with post-operative semen analysis data available. Patency was defined as the presence of motile sperm in the ejaculate at six months post-operatively. Men who did not meet this criteria, but had unassisted clinical pregnancies were also considered patent. Men with a sperm concentration <100,000/mL and/or <6 month follow-up were considered not patent. We have been using the LIVE technique since 2002 and compared the outcomes of LIVE to the previous techniques. RESULTS: Mean patient age was 42.1 7.5 years old. 49 (57%) cases were due to infection, while 38 (43%) had a previous vasectomy as etiology. For the post-vasectomy cases, mean time since vasectomy was 12.8 4.8 years. Regarding the VE technique used, 20 (23%) were LIVE cases and in 67 (77%) cases other techniques were used. The overall mean post-operative follow-up time was 18.2 23 months. Overall patency rate was 81%. The patency rate for the LIVE cases was 85% and for the other techniques it was 79%, p1⁄40.125. CONCLUSIONS: Longitudinal intussusception microsurgical vasoepididymostomy (LIVE) technique is an effective way to treat patients with epididymal obstruction when compared with other techniques.