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Biomedical subjects

A M Belker

Publications and source records attributed to A M Belker.

At least 19 recordsLinked to original sources
PubMed1991

Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group.

During a 9-year period 1,469 men who underwent microsurgical vasectomy reversal procedures were studied at 5 institutions. Of 1,247 men who had first-time procedures sperm were present in the semen in 865 of 1,012 men (86%) who had postoperative semen analyses, and pregnancy occurred in 421 of 810 couples (52%) for whom information regarding conception was available. Rates of patency (return of sperm to the semen) and pregnancy varied depending on the interval from the vasectomy until its reversal. If the interval had been less than 3 years patency was 97% and pregnancy 76%, 3 to 8 years 88% and 53%, 9 to 14 years 79% and 44% and 15 years or more 71% and 30%. The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures and they were statistically the same for all patients regardless of the surgeon. When sperm were absent from the intraoperative vas fluid bilaterally and the patient underwent bilateral vasovasostomy rather than vasoepididymostomy, patency occurred in 50 of 83 patients (60%) and pregnancy in 20 of 65 couples (31%). Neither presence nor absence of a sperm granuloma at the vasectomy site nor type of anesthesia affected results. Repeat microsurgical reversal procedures were less successful. A total of 222 repeat operations produced patency in 150 of 199 patients (75%) who had semen analyses and pregnancy was reported in 52 of 120 couples (43%).

Adult↗
PubMed1990

The high rate of noncompliance for post-vasectomy semen examination: medical and legal considerations.

The records of 1,029 consecutive patients undergoing bilateral vasectomy were reviewed. Of the 1,029 patients 375 (36%) never returned postoperatively and the partners of 2 of these 375 later became pregnant. A total of 560 patients (54%) was followed until the recommended demonstration of azoospermia occurred on 2 consecutive occasions. There were 84 patients (8%) who did not return after the first demonstration of azoospermia, while 7 (1%) still had sperm in the semen at the last examination. Three other patients had persistent nonmotile sperm postoperatively; 2 of them underwent repeat vasectomy followed by azoospermia and 1 was placed in a special clearance category of sterility as described. We discuss practical and legal considerations regarding the management of noncompliant patients.

Female↗
PubMed1990

Transrectal prostate ultrasonography as a diagnostic and therapeutic aid for ejaculatory duct obstruction.

Preoperative transrectal ultrasonography was used to establish the diagnosis of ejaculatory duct obstruction and also to determine the distal level of extension of the obstructed system within prostatic parenchyma. Transrectal ultrasonography not only established the diagnosis but also enabled precise transurethral resection into the obstructed system. Prostatic ultrasound facilitates evaluation and treatment of azoospermia caused by ejaculatory duct obstruction and may eliminate the need for vasography in such cases.

Adult↗
PubMed1990

Vasectomy: an appraisal for the obstetrician-gynecologist.

Data regarding the efficacy of vasectomy are limited, but the procedure appears to be highly effective. Efficacy may vary by the method of vas occlusion. Death attributable to vasectomy in the United States is exceedingly rare, and major perioperative morbidity is quite uncommon. No long-term adverse health effects have been documented, and much evidence supports the conclusion that vasectomy does not increase the risk of subsequent atherosclerosis. Vasectomy, like tubal sterilization, should be considered a permanent decision, because reversal surgery is expensive and requires substantial surgical expertise. Although vasectomy reversal is often successful, it cannot be guaranteed even in the best of circumstances, and when the vasectomy has caused epididymal obstruction, reversal is often unsuccessful. Vasectomy represents a safe and effective alternative to tubal sterilization for couples who decide that the male should be sterilized.

Female↗
PubMed1988

Infrapubic incision for specific vasectomy reversal situations.

Routine vasectomy reversals are performed easily through scrotal incisions. However, the infrapubic incision offers easiest access to both ends of the vas deferens when the vasectomy has been performed at an unusually high level. Similarly, when unusually long segments of the vas have been removed during the vasectomy, the infrapubic incision enables the surgeon to mobilize a sufficient length of the abdominal end of the vas so that even vasoepididymostomy may be performed without tension on the anastomosis. Technical details of the infrapubic incision, which may be used with local anesthesia, are described.

Adult↗
PubMed1988

Applications of microsurgery in urology.

The applications of microsurgery in urology have increased in the decade since urologists first used such techniques. The primary uses for microsurgery in urology at first were vasovasostomy, vasoepididymostomy, and testicular autotransplantation. Penile revascularization has recently become another procedure for which microsurgery is used with increasing frequency. As more urologists learn the techniques, other urologic applications for microsurgery surely will develop.

Cryptorchidism↗
PubMed1987

Young's syndrome: an often unrecognized correctable cause of obstructive azoospermia.

Young's syndrome consists of azoospermia owing to bilateral epididymal obstruction in patients with chronic sinus and pulmonary infections. Azoospermia may be corrected by vasoepididymostomy in these patients but postoperative fertility rates are yet to be determined. Because the infertility of Young's syndrome potentially is remediable with vasoepididymostomy and because the syndrome is observed commonly by surgeons outside of this country, we report 2 cases to illustrate what may be a frequently unrecognized and potentially correctable cause of azoospermia.

Adult↗
PubMed1987

Sperm processing and intrauterine insemination for oligospermia.

The success of IVF has led to the adaptation of IVF sperm processing methods for WIUI. When WIUI is used for treating oligoasthenospermia, there is a theoretical advantage because an isolated population of only the most motile, capacitated sperm are placed directly into the wife's uterus. The cervix and its mucus are bypassed, which may provide a mechanical or biochemical advantage for semen from subfertile males. Removal of seminal plasma (and prostaglandins contained therein) prevents the painful uterine contractions that can occur when raw semen is placed directly into the uterine cavity. The disadvantages of WIUI are related to its expense, problems with precise timing of ovulation, and the frustration that can occur when inseminating personnel are not available whenever ovulation occurs on weekends or holidays. Only truly committed couples who will try WIUI for multiple cycles should be selected for this method of infertility treatment. Although male-factor infertility currently is one of the main indications for WIUI, the widely variable pregnancy rates reported with WIUI leave some doubt regarding its ultimate role in the treatment of this condition. Our own preliminary results with WIUI for treatment of asthenospermia, oligoasthenospermia, and "cervical factor" infertility are encouraging, although the numbers of patients are small. We anticipate that with further refinement of methods of sperm processing and with the newer improved methods of home monitoring of ovulation, these results may improve. Factors that determine pregnancy rates of WIUI for the treatment of oligoasthenospermia are numerous. The degree of oligospermia and/or asthenospermia, the cooperation and persistence of the couple through the required cycles of WIUI (drop-out rate), the method and meticulousness of sperm processing, the accuracy of monitoring ovulation, the availability of insemination personnel whenever ovulation occurs (even on weekends and holidays), and possibly the duration of infertility will all play a role in the ultimate success of WIUI programs. Couples selecting WIUI must be aware that it does not now offer a high pregnancy rate when used for treatment of male-factor infertility. The apparent increased pregnancy rate of WIUI compared with other methods of AIH may have resulted from modern methods of monitoring ovulation. Studies have not yet been performed to show whether comparable pregnancy rates would be obtained if similar methods of monitoring ovulation were used with cervicovaginal methods of AIH. We believe the only clear indication for WIUI now is an abnormal sperm-cervical mucus interaction.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMed1987

Accreditation of ambulatory surgery centers.

Accreditation is required for outpatient surgery facilities not only to assure quality patient care but also to obtain a facility fee reimbursement from many insurance companies. General guidelines concerning subjects considered by the JCAH and the AAAHC in the accreditation process have been reviewed. Because actual physical construction features may affect accreditation, those planning office-based and other types of outpatient surgery facilities should be aware of accreditation requirements before construction is begun.

Accreditation↗
PubMed1987

Vasectomy reversal.

A vasovasostomy may be performed on an outpatient basis with local anesthesia, but also may be performed on an outpatient basis with epidural or general anesthesia. Local anesthesia is preferred by most of my patients, the majority of whom choose this technique. With proper preoperative and intraoperative sedation, patients sleep lightly through most of the procedure. Because of the length of time often required for bilateral microsurgical vasoepididymostomy, epidural or general anesthesia and overnight hospitalization are usually necessary. Factors influencing the preoperative choice for vasovasostomy or vasoepididymostomy in patients undergoing vasectomy reversal are considered. The preoperative planned choice of vasovasostomy or vasoepididymostomy for patients having vasectomy reversal described herein does not have the support of all urologists who regularly perform these procedures. My present approach has evolved as the data reported in Tables 1 and 2 have become available, but it may change as new information is evaluated. However, it offers a logical method for planning choices of anesthesia and inpatient or outpatient status for patients undergoing vasectomy reversal procedures.

Ambulatory Surgical Procedures↗
PubMed1986

Alloplastic spermatocele: poor sperm motility in intraoperative epididymal fluid contraindicates prosthesis implantation.

After vasectomy reversal by vasovasostomy or vasoepididymostomy motile sperm appear commonly in the semen even when only nonmotile sperm are present in the intraoperative vasal or epididymal fluid. We studied patients with bilateral congenitally absent vasa deferentia to see if relief of obstruction by implantation of an alloplastic spermatocele also benefits sperm motility in such patients. A total of 130 alloplastic spermatoceles was implanted in 91 patients. Of 21 patients with only nonmotile sperm in the epididymal fluid intraoperatively only 1 had motile sperm in the postoperative aspirates from the alloplastic spermatocele. The quality of sperm motility in the intraoperative epididymal fluid was predictive of the quality of sperm motility in the postoperative aspirates. Conception postoperatively did not occur whenever less than 20 per cent of the intraoperative epididymal sperm was motile. Thus, poor or absent sperm motility in the epididymal fluid during planned alloplastic spermatocele implantation predicts a poor postoperative result and, therefore, contraindicates implantation of the prosthesis. Pregnancy, which occurred postoperatively in 7 of 91 wives, ended in spontaneous abortion in 3 and progressed to full-term delivery in 4.

Body Fluids↗
PubMed1985

Transient fertility after vasovasostomy in 892 patients.

We report on the low incidence of transient fertility in 892 patients who underwent microsurgical vasovasostomy. Of the 892 patients in whom fertile sperm concentrations (as defined by us) developed 2 to 8 months postoperatively 28 later suffered azoospermia or severe oligospermia. The wives of 5 of the 28 patients with such transient postoperative fertility became pregnant before the patients became azoospermic or severely oligospermic again.

Fertility↗
PubMed1985

Transseptal crossed vasovasostomy.

We examined 11 patients with acquired obstructive azoospermia resulting from irreparable obstruction of 1 vas deferens and severe damage to the contralateral testis. All of the patients underwent transseptal crossed vasovasostomy with no morbidity. Of 8 patients evaluated with postoperative semen analyses 4 (50 per cent) demonstrated total sperm counts of 29 to 205 million and 2 pregnancies (25 per cent) have been reported, with followup ranging from 5 months to 2 years. The etiologies of the vasal obstruction included previous inguinal surgery in 7 patients, vasectomy in 1, ejaculatory duct obstruction in 1, ectopic ureter in 1 and vasal agenesis in 1. Factors leading to loss of the contralateral testis were torsion in 5 patients, mumps orchitis in 2, varicocele in 1, pediatric inguinal herniorrhaphy in 1, epididymal blow out in 1 and unknown in 1. A representative case involving a unilateral ectopic ureter emptying into the seminal vesicle and subsequent contralateral testicular torsion is presented. The results indicate that a transseptal crossed vasovasostomy should be done in patients satisfying the criteria presented.

Adult↗
PubMed1985

Vasectomy and its reversal.

Techniques, results, complications, and medicolegal aspects of vasectomy are discussed in this article. Emphasis is placed on techniques that prevent spontaneous recanalization of the ends of the vas deferens after vasectomy. Factors that affect the reversibility of vasectomy are discussed. New microsurgical techniques of vasectomy reversal are described, and results of these new techniques are compared with results of nonmicrosurgical techniques of vasectomy reversal. Indications for bypass vasoepididymostomy during vasectomy reversal procedures, as well as techniques for performing vasoepididymostomy, are discussed.

Antibodies↗
PubMed1984

Relationship of gross appearance of vas fluid during vasovasostomy to sperm quality, obstructive interval and sperm granuloma.

To study its intraoperative significance the gross appearance of the vas fluid found during vasovasostomy was compared to the quality of sperm in the fluid, obstructive interval and presence or absence of a histologically proved sperm granuloma. Data were obtained from 648 vasa in 340 patients. As the gross appearance increased in opacity, there was a small decrease in the proportion of morphologically normal, motile sperm (23 to 7 per cent) and a corresponding small increase in the proportion of sperm without tails (2 to 12 per cent). These minor trends had statistical but no intraoperative surgical significance. There was no variation in the proportion of vas fluid azoospermia with gross appearance. There was no significant difference in the gross appearance of the vas fluid with increasing obstructive interval. Finally, the presence or absence of a sperm granuloma had no effect on the gross appearance of the vas fluid, and the appearance had no predictive value relative to sperm granuloma. We conclude that the gross appearance of the vas fluid should not be used as a basis for operative decision-making during vasovasostomy.

Exudates and Transudates↗
PubMed1983

Intraoperative observations during vasovasostomy in 334 patients.

This initial report from the Vasovasostomy Study Group concerns intraoperative data obtained during vasovasostomy from 639 vasa in 334 patients. These data are related to the obstructive interval (time from vasectomy to vasovasostomy) and to the presence or absence of histologically proved sperm granuloma at the old transected testicular end of the vas (vasectomy site). Rates of sperm absence from vas fluid at the testicular end increased with longer obstructive intervals and with absence of a sperm granuloma. If sperm were present in fluid at the testicular end of the vas, the quality was poorer when the obstructive interval lengthened and when sperm granuloma was absent. Vas luminal diameters at the testicular end were smaller when a sperm granuloma was present. These observations support the theory that a sperm granuloma at the vasectomy site may have a beneficial, pressure-releasing effect that could be favorable prognostically for fertility after vasovasostomy.

Granuloma↗