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Titolo:
Vasovasostomy versus MESA/TESE combined with ICSI - a cost benefit analysis
Autore:
Heidenreich, A; Altmann, P; Neubauer, S; Engelmann, UH;
Indirizzi:
Univ Cologne, Klin & Poliklin Urol, Med Einrichtungen, D-5000 Cologne 41, Germany Univ Cologne Cologne Germany 41 inrichtungen, D-5000 Cologne 41, Germany
Titolo Testata:
UROLOGE A
fascicolo: 3, volume: 39, anno: 2000,
pagine: 240 - 245
SICI:
0340-2592(200005)39:3<240:VVMCWI>2.0.ZU;2-P
Fonte:
ISI
Lingua:
GER
Soggetto:
INTRACYTOPLASMIC SPERM INJECTION; IN-VITRO FERTILIZATION; VASECTOMY REVERSAL; MICROSURGICAL VASOEPIDIDYMOSTOMY; NEEDLE-BIOPSY; EMBRYOS; QUESTIONNAIRE; PREGNANCIES; INFERTILITY; ASPIRATION;
Keywords:
vasovasostomy; refertilization; cost benefit analysis; reproduction; pregnancy rate;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Heidenreich, A Univ Marburg, Klin & Poliklin Urol, Baldingerstr, D-35033 Marburg, Germany Univ Marburg Baldingerstr Marburg Germany D-35033 Germany
Citazione:
A. Heidenreich et al., "Vasovasostomy versus MESA/TESE combined with ICSI - a cost benefit analysis", UROLOGE A, 39(3), 2000, pp. 240-245

Abstract

WS represents the standard procedure of choice for the treatment of obstructive azoospermia following vasectomy. However, recently, ICSI has been suggested by some to represent the solution for all cases of male factor infertility regardless of its etiology based on its success rates. Therefore, wecompared WS to MESA/TESE and ICSI in terms of pregnancy, complications, and costs. Between 1/93 and 6/98 157 VVS was performed microsurgically using the 2-layer technique in 157 patients following prior vasectomy. Between 9/94 and 9/97 69 couples underwent MESA/ICSI for epididymal obstruction not amenable to microsurgical reconstruction such as postinfiammatoryobstructionand congenital absence of the vas deferens; in the same time period 42 couples underwent TESE/ICSI for azoospermia of testicular origin due to cryptorchidism, testicular atrophy,obstruction of the rete testis. In most cases MESA or TESE acid ICSI were performed metachronously. Mean intervall of vasal obstruction was 7.6 (0.5-18) years; patency after WS was 77%, pregnancy rate was 52%. local complication rate was 4.7%, no major complications wereobserved. Costs per life birth after WS were as high as 5.447,- DM or 2.800 Euro. Pregnancy rates after MESA/TESE and ICSI were 22.5% and 19.5%, respectively with 16 singletons, 3 twins and 3 abortions; local complications occured in 3.9% of the men. Multiple birth were noticed in 15.8% following ICSI, but only in 0.7% following WS.5.7% and 1.4% of the female partners experienced serious complications as a mild or severe ovarian hyperstimulation-syndrome, respectively. Costs per life birth after MESA/TESE cycle were ashigh as 28.804,- DM or 14.100 Euro. Even in the era of ICSI microsurgical vasovasostomy represents the standard approach for obstructive azoospermia following vasectomy. Based on a cost-benefit analysis WS is more successfulin terms of pregnancy rates (52% vs. 22.5%). We conclude that MESA/ICSI should be reserved for patients not amenable for microsurgical reconstruction.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/09/20 alle ore 11:49:07