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Purpose <p>To examine associations of adjunctive oral escin, prior percutaneous epididymal sperm aspiration (PESA), and early postoperative ejaculatory frequency with time to and final technical patency after microsurgical vasoepididymostomy (MVE), and to derive an exploratory prognostic model for individualized counseling.</p> Methods <p>We conducted a retrospective cohort study of 134 men with obstructive azoospermia (OA) who underwent MVE between June 2022 and August 2024. Patients received standard care alone (Control Cohort, <i>n</i> = 71) or standard care plus adjunctive oral escin (Combined Cohort, <i>n</i> = 63). Key variables included prior PESA and self-reported postoperative ejaculatory frequency during the first 3 months (&lt; 2 vs. ≥2 times/week). Final technical patency was defined as the presence of any sperm in the ejaculate during follow-up. Time to patency was analyzed in the full cohort using Kaplan–Meier curves and multivariable Cox regression, with patients who remained non-patent by 12 months treated as right-censored observations at 12 months. Independent predictors of final technical patency were evaluated using multivariable logistic regression. To ensure model stability, an exploratory prognostic model was constructed using the independent predictors, and its discrimination was assessed by ROC analysis.</p> Results <p>The Combined Cohort showed a higher final technical patency rate than the Control Cohort (87.3% vs. 73.2%, <i>P</i> = 0.043) and a shorter time to patency (log-rank <i>P</i> &lt; 0.001). In multivariable Cox analysis, adjunctive escin was associated with earlier patency (HR = 1.645, <i>P</i> = 0.013), whereas prior PESA was independently associated with delayed patency (HR = 0.505, <i>P</i> = 0.001). Bilateral anastomosis (HR = 2.627, <i>P</i> = 0.006) and high postoperative ejaculatory frequency (HR = 1.916, <i>P</i> = 0.005) were also independently associated with earlier patency. In multivariable logistic regression, prior PESA was independently associated with lower final patency (OR = 0.238, <i>P</i> = 0.043), whereas bilateral anastomosis (OR = 5.039, <i>P</i> = 0.040) and high postoperative ejaculatory frequency (OR = 3.004, <i>P</i> = 0.041) were independently associated with higher final patency. The refined prognostic model demonstrated good discrimination (AUC = 0.778) and achieved an events-per-variable ratio of 9.0.</p> Conclusion <p>Modifiable perioperative factors were associated with MVE outcomes. Adjunctive escin was associated with earlier technical patency but not independently with final technical patency. High ejaculatory frequency during the first 3 months was associated with both earlier and higher final technical patency, whereas prior PESA was associated with delayed and lower patency. These findings may inform perioperative counseling, but should be interpreted as observational and exploratory.</p>

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Modifiable predictors of patency after microsurgical vasoepididymostomy: associations of adjunctive escin, prior percutaneous epididymal sperm aspiration, and postoperative ejaculatory frequency

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Jihai Liu,
  • Yisong Ju,
  • Haoqiang Zhang,
  • Lei Qian,
  • Qiuling Yue,
  • Qingqiang Gao,
  • Tao Song,
  • Wen Yu,
  • Xiaozhi Zhao

摘要

Purpose

To examine associations of adjunctive oral escin, prior percutaneous epididymal sperm aspiration (PESA), and early postoperative ejaculatory frequency with time to and final technical patency after microsurgical vasoepididymostomy (MVE), and to derive an exploratory prognostic model for individualized counseling.

Methods

We conducted a retrospective cohort study of 134 men with obstructive azoospermia (OA) who underwent MVE between June 2022 and August 2024. Patients received standard care alone (Control Cohort, n = 71) or standard care plus adjunctive oral escin (Combined Cohort, n = 63). Key variables included prior PESA and self-reported postoperative ejaculatory frequency during the first 3 months (< 2 vs. ≥2 times/week). Final technical patency was defined as the presence of any sperm in the ejaculate during follow-up. Time to patency was analyzed in the full cohort using Kaplan–Meier curves and multivariable Cox regression, with patients who remained non-patent by 12 months treated as right-censored observations at 12 months. Independent predictors of final technical patency were evaluated using multivariable logistic regression. To ensure model stability, an exploratory prognostic model was constructed using the independent predictors, and its discrimination was assessed by ROC analysis.

Results

The Combined Cohort showed a higher final technical patency rate than the Control Cohort (87.3% vs. 73.2%, P = 0.043) and a shorter time to patency (log-rank P < 0.001). In multivariable Cox analysis, adjunctive escin was associated with earlier patency (HR = 1.645, P = 0.013), whereas prior PESA was independently associated with delayed patency (HR = 0.505, P = 0.001). Bilateral anastomosis (HR = 2.627, P = 0.006) and high postoperative ejaculatory frequency (HR = 1.916, P = 0.005) were also independently associated with earlier patency. In multivariable logistic regression, prior PESA was independently associated with lower final patency (OR = 0.238, P = 0.043), whereas bilateral anastomosis (OR = 5.039, P = 0.040) and high postoperative ejaculatory frequency (OR = 3.004, P = 0.041) were independently associated with higher final patency. The refined prognostic model demonstrated good discrimination (AUC = 0.778) and achieved an events-per-variable ratio of 9.0.

Conclusion

Modifiable perioperative factors were associated with MVE outcomes. Adjunctive escin was associated with earlier technical patency but not independently with final technical patency. High ejaculatory frequency during the first 3 months was associated with both earlier and higher final technical patency, whereas prior PESA was associated with delayed and lower patency. These findings may inform perioperative counseling, but should be interpreted as observational and exploratory.