Infertility & Sexual Dysfunction(구연) Oral Session 2 / Infertility & Sexual Dysfunction (O-014) Crystal A (3F) 11월28일(수) 13:00-14:00 시험관아기시술 시대에 폐쇄성무정자증의 치료로서 부고환정관문합술의 역할: 체계적 문헌고찰 및 메타분석 ¹차의과학대학교 의학전문대학원 비뇨의학과교실,²국민건강보험공단 일산병원 비뇨의학과,³한양대학교 의과대학 비뇨의학과 김대근¹,이형호²,박성열³,문홍상³,김동석¹,송승훈¹,윤영은³ Objective: To investigate the outcome of microsurgical vasoepididymostomy (MVE) on epididymal obstructive azoospermia (EOA) by systematic review and meta-analysis. Materials and Methods: A comprehensive literature search was performed using Medline, Embase, and Cochrane library including all studies related with MVE. Included keywords were “vasoepididymostomy,” “epididymovasostomy,” “epdididymal obstruction,” and “epididymis obstruction”. Event rate and risk ratio (RR) was estimated by random-effects model. Heterogeneity was investigated by I2 statistic. Results: From total 1422 articles, 42 observational studies were included and enrolled with 2298 patients up to Jan 2017. Each study included either patency rate or pregnancy rate after MVE. The overall mean patency rate after MVE was 64.1% (95% confidence interval [CI], 58.5%-69.3%, I2 =83.0%), and the overall mean pregnancy rate was 31.1% (95% CI 26.9%-35.7%, I2 =73.0%). In terms of surgical technique, the patency rate of end-to-end or side technique was 61.1% and intussusception technique was 69.1%. A meta-analysis comparing the patency of bilateral MVE and unilateral MVE revealed RR of 1.38 (95% CI 1.21-1.57, p<0.00001). The patient who had motile sperm from epididymal fluid revealed RR of 1.53 (95% CI 1.21-2.13, p=0.01) on patency rate. Comparing the site of MVE revealed RR of 1.17 (95% CI 1.01-1.35, p=0.04) which was favorable for caudal or corpus area on patency rate. Conclusion: MVE is an effective treatment for EOA that can improve male fertility. We find that performing MVE bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate. keywords : Azoospermia, Meta-analysis, Vasoepididymostomy