Reproductive Surgery

 

Men

Male Reproductive System includes two testes, a network of ducts, the seminal vesicles, the prostate gland and the penis. Sperms are produced in testis and ejaculated through penis. From the production to the delivery the track is very long – In short the pathway for sperms is from

Seminiferous Tubules straight tubules Rete testis efferent ductules Epididymis Vas deferens urethra. There can be blockage at any level and few of them can be treated surgically. Few disorders of male reproductive system which can be treated surgically are as follows.

A. Disorders of the Scrotum, Testicles, Epididymis and Ejaculatory duct.

1
Testicular trauma & Torsion––Can occur due to mild injury to the testicles. Testicles torsion,
when one of the testicles twists  around.
–Surgery can untwist the cord and save the testicle
2
Varicocele–Abnormal dilated testicular veins of the scrotum.
3
Hydrocele–It occurs when fluid collects in the membranes surrounding the tests
–Surgery can correct the condition
4
Inguinal hernia–when a portion of the intestines pushes through an abdominal   opening or weakening of the abdominal wall and into the groin or    scrotum, it is known as inguinal hernia. Hernia may look like a bulge   or swelling in the groin area.
–Hernia can be corrected through surgery and as Vas pass through
inguinal canal, repair of hernia will help in sperm quality and quantity.
5
Repositioning of undescended testis–Testis does not descend and settle in scrotum, it remains in the   inguinal canal,  Testis can be brought back to scrotal sac in early   childhood [5-7 years].
– For adults surgery is helpful only to prevent testicular cancer it will    not be useful for reproduction.
6
Vas Deferens or
Epididymal blockage
Vasovasostomy

Vasoepididymostomy

–It can be due to infection or traumatic injury

–~5% vasectomized men undergo this surgery to restore sperm
delivery
–This can correct the block the epididymis

7
Ejaculatory duct obstruction–Pathology is usually blockage of the ducts within the Prostate by  stones, cysts or scar tissue.

B. Disorders in the Penis: Correction of penile deformities

C. Anejaculation – absence of ejaculation

D. Sperm Extraction Procedures

When there is sperm production in the testis but unable to enter into ejaculatory system, sperm has to be recovered from vas, epididymis or testis, depending upon the location of extraction. Various techniques has been developed TESA, PESA, MESA etc . This sperm can be used for IVF-ICSI.

Some of the structural abnormalities of male reproductive tract can be corrected with surgery. To treat specific medical condition or to enhance sperm production medical therapy is applicable.

Anejaculation
[Absence of Ejaculation]
Causes   Treatment
Psychological Situational or occasional
  1. Under stressful conditions like before IUI or IVF on demand they can’t produce
  2. Men cannot ejaculate with some partner
  3. Professional (or) personal tensions
counselling
psychosexual drugs
use of vibrator

Physical

  1. Pelvic nerve damage
  2. Uncontrolled diabetes mellitus
  3. Multiple  Sclerosis
  4. pelvic surgery
  5. spinal card injury
Electro ejaculation
[Electrical stimulus is given to ejaculate]
Azoospermia Causes

Hormone
Disorde

Testicular
delivery
Varicocele
vein in the cord
Drugs

Sperm delivery

Hormone deficiency of Pituitary gland LH, FSH Prolactin, thyroid hormone,Hypothalamic deficiency of GnRH, Pituitary gland failure Hypopituitarism,Idiopathic
Hypopituitarism, kallman
Syndrome,isolatedHypogonadism, Drugs,Toxins etc.

Obstruction in the outflow
Of semen because of
-Absent vas deference
-Absent seminal vesicle
-Post traumatic, Post  surgical   Ligation of vas  deference,
-Infection of Chlamydia or   Gonadococeus, due to  post   Tubercular  epididimoorchitis
-If sperms are immotile in   testis  It might not come  out   because of immotile  cilia   syndrome,Kartagener   syndrome,  cystic    Fibrosis
-Absence of germ cell in
Testis [sertoli cell  syndrome]     No sperm  forming cell in testis
-Maturation arrest [Spermatid   arrest] Due to local, systemic  hormonal Growth  deficiency.

[Primary Leyding cell Dysfunction]that connects to the testicle– Spironolactone
– alcohol
– Ketoconazole
– cyelsphosphamide
– estrogen    administration
– sulfasakzine
– ductal absence   orblockage

Azoospermia Treatments
[Treatment depends upon the cause of Azoospermia]

[Correction of the cause] 
 Correction of hormone deficiencies
Surgery

No Spermatogenesis                   
[Hypo         spermatogenesis]

Gonadotropin therapy [natural stimulator
of sperm production in the testis] Growth hormone therapy
Gn-RH analoges,
Growth factor, Mineral, Micro nutrient therapy
Free radical scavengers
Bromocriptine in case of high prolactin
Correction of thyroid hormone
Correction of congenital adrenal hyperplasia

  Obstruction azoospermia

  • Correction of block some time
    restore the track
  • Testicular sperm aspirationand IVF – ICSI deferens
Non obstructive azoospermia

  • Testis sperm extraction [TESE]
  • Testis sperm aspiration [TESA]
  • Sperm Donation
  • Adoption

Facility at our center

  • History and Physical examination
  • Hormone test
  • Semen analysis with centrifuged pallet
  • Testis biopsy and fine needle aspiration to determine sperm production within testis
  • Genitic testing and conseling services for these men who has genetic reason for azoospermia
 Epididymal, aspiration [MESA, PESA]
Indication
Procedure
When there is a block beyond epidydimisIt can be performed either through a small incision or a direct needle puncture through the scrotal skin & sperms are recovered from epididymis
Sperm are injected into an egg by Process of ICSI

Testicular Sperm Extraction [TESE, TESA]

Indication
Procedure
Men in whom there is a blockage in the Epididymis very close to where it connects toTestis.

It can occur either from prior surgery, infection
Or
Blockage within the ducts that conduct sperms Out of the testicle

Testis tissue is specially treated in the laboratory to separate sperms.
Sperms are injected in to an egg through ICSI

Vas Deferens or Epididymal blockage 

Reproductive tract of men is a basically one long tube 

Cause for blockage
Treatment

Facility with us

Injury to the genital tract due to STD Vasectomy Incurred during other surgicalProcedurevasectomy reversal Vasovasostomy EpididymostomyWe provide all the surgical procedures  mentioned above

Ejaculatory Duct obstruction

Cause for obstruction
Surgical Treatment
Facility with us
Result of surgical scarring during  vasectomy procedure cancerous tumors cysts that grow in the prostatesurgery may restore the ejaculation of semen We do provide this surgical procedure

Varicolcele
[Abnormal dilated testicular veins of the scrotum]

Symptoms surgical
Diagnosis
Treatment
  • Acne in the testicle
  • Feeling of heaviness
    In the testicles
  • Infertility Shrinkage [atrophy] of the testicles
  • Visible or palpable [able to felt] enlarged vein
  • physical examination
  • scrotal ultrasonography

 Grading:
I   – Present only with valsalva
II  – prevent without valsalva
III – visible through the skin

  • varicocelectomy – The surgical removal or ligation of varicose veinsin the scrotal sac
  • Laparoscopic surgery

Facility at our center:

  • ultrasound technique to diagnose varicocele
  • surgical treatment like laparoscopy and incisional techniques – “come and go” basis
  • Laparoscopic varicocelectomy or conventional technique
  • Non-surgical treatment options – X-ray immobilization