Dennis Lusaya | University of Santo Tomas, Phils (original) (raw)

Papers by Dennis Lusaya

Medical & Surgical Urology, 2015

Philippine Journal of Urology, 2019

Endourology Progress, 2019

Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no ... more Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no longer suitable for extracorporeal shockwave lithotripsy. The key to success depends on the urologist’s choice of instruments, preoperative and intraoperative access planning, patience, perseverance, skill and training. Percutaneous renal access is a crucial early step that may ultimately influence outcomes of PCNL in terms of overall stone-free rate and complications. Several techniques for access and tract dilatation are described in this chapter. Prone, supine or lateral positioning during renal access have inherent advantages and disadvantages. Similarly, various adjunct imaging modalities and instrumentation are available to increase success and decrease the risk of complications. Nonetheless, the most practical and effective approach still depends heavily on stone burden and renal anatomy, available instrumentation and equipment, and the surgeon’s expertise and level of training.

Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most pat... more Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most patients present with hematuria, suprapubic pain and dysuria. Presented is a case of a 44 year old male with 4 month history of hematuria and terminal dysuria who underwent radical cystoprostatectomy with histopathology findings of mucinous adenocarcinoma. Upon diagnosis, 25% of patients have distant metastases and 50% have stage IV disease with 50% five years survival rate for stage I-III tumor with no stage IV patients surviving beyond two years. Hence, for this type of cancer, early diagnosis is crucial. Surgery is the mainstay of treatment and is resistant with chemotherapy and radiation. Thus, for patient with confirmed or highly suspicious mucinous adenocarcinoma of the bladder, timely radical resection is warranted.

This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms a... more This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms and an elevated prostate specific antigen (PSA) of 48.21ng/ml. Multiparametric MRI of the prostate revealed a markedly enlarged prostate (225grams) with a PIRADS 5 lesion at the left posterior peripheral zone. Prostate biopsy done revealed prostate adenocarcinoma Gleason 7(3+4). Metastatic workup was negative for distant metastasis hence the patient was advised robot-assisted laparoscopic prostatectomy (RALP). Several difficulties were encountered during the surgical technique. The usual posterior approach was not feasible because incising the peritoneum over the rectovesical pouch would not be able to expose the vas deferens and seminal vesicles. An anterior approach was instead done, but this was still difficult due to the lack of space for proper exposure and movement of instruments. The posterior dissection was also challenging; three successive suspension stitches were necessary in o...

World Journal of Urology, 1995

Continuing experience with the use of Nd: YAG laser-fibre prostatectomy over the past 4 years has... more Continuing experience with the use of Nd: YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months

Journal of the American College of Surgeons, 2014

World Journal of Urology, 1995

Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has ... more Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months of follow-up, respectively. The American Urological Association (AUA) symptom scores, peak uroflow (Qmax) rates and post-void residual urinary volumes show marked improvement. Following laser ablation of the prostate (LAP), complications have included 16 patients with post-procedural recurrent obstructive symptoms requiring revision. Three patients developed urinary tract infection, two developed bladder-neck stenosis, four fully anticoagulated patients with clot retention required blood transfusion and three patients had epididymo-orchitis. The results show a sustained reduction in AUA symptom scores and maintained improvement in peak flow rates and residual volumes, with stabilization of the above-mentioned parameters occurring within 12-36 months. The results demonstrate the continued durability of the outcome of LAP.

Journal of Endourology, 1994

Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-p... more Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-prototype visual urethrotome was evaluated for the management of submucosal vesicoureteral stones and as an aid in the removal of a Dormia basket with an entrapped stone impacted in the submucosa of the vesical portion of the ureter. A total of 14 male and 11 female adult patients were included. Fifteen patients required ureteral meatotomy to release the stone. Transurethral ureteral meatotomy is a precise and safe procedure associated with minimal complications when carefully done. Our local-prototype instrument proved to be a simple, economical, and valuable tool.

Journal of Endourology, 1995

Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has sh... more Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has shown encouraging results. Thus far, of the 198 patients treated with the 60 W/60 seconds technique since October 1990, a total of 74 were available for long-term evaluation (69 at 12 months and 29 at 24 months). The AUA Symptom Scores, Qmax (peak uroflow rates), and postvoiding residual urine volumes demonstrated marked improvement. The complications included 16 instances of recurrent obstructive symptoms necessitating revision. Three patients suffered urinary tract infections, two patients developed bladder neck stenosis, four anticoagulated patients with clot retention required blood transfusions, and three patients had epididymoorchitis. Follow-up at 12 and 24 months showed sustained reduction in AUA Symptom Scores and maintained improvement of the peak flow rates and residual volumes. These results demonstrate the safety and clinical applicability of laser ablation of the prostate and its potential usefulness as a less invasive therapy for benign hyperplasia.

Current Opinion in Urology, 1994

Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its... more Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its ability to ablate hyperplastic tissue successfully. This therapy has emerged to challenge transurethral resection of the prostate (TURP), considered to be the'gold standard'of ...

Microsurgical Subinguinal Varicocelectomy for Male Infertility Jonathan Mendoza, MD Urology Resi... more Microsurgical Subinguinal Varicocelectomy for Male Infertility

Jonathan Mendoza, MD
Urology Resident
Institute of Urology
St. Luke’s Medical Center, QC
Philippines

Dennis G. Lusaya, MD FPUA, FPCS
Chairman Institute of Urology
St. Luke’s Medical Center, Quezon City
Associate Professor. Department of Surgery/Urology
University of Santo Tomas, Manila, Philippines

ABSTRACT

Introduction: Varicoceles represent the most common attributable cause of primary and secondary infertility in the male. A number of studies have established the effect of performing varicocelectomy in order to improve semen parameters. Several techniques of varicocelectomy has been described in literature, however, the microsurgical technique has been considered as the gold standard in doing this procedure.
Objective/s: The study primarily aims to establish the effect of microsurgical varicocelectomy on post-operative semenalysis when compared to baseline semenalysis. We also aim to establish the impregnation rate and the span at which impregnation occur following varicocelectomy. Lastly, we describe our technique and modifications of microsurgical subinguinal varicoelectomy performed by a single surgeon using an operating microscope and microdoppler throughout the procedure.
Materials and Methods: Microsurgical subinguinal varicocelectomy was performed on 37 patients in our institution from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade, operative time, intraoperative findings, postoperative complication, and 3-month follow-up semenalysis results were recorded and compared. Successful impregnation of the partner and the number of months from the operation to the successful impregnation were also recorded.
Results: Three months postoperative semenalysis parameters were compared to the baseline semenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60, postoperatively with p-value of 0.010. There was no significant difference observed in the total count, concentration, and percent immature forms. Eleven or 30% ofpatients were able to successfully impregnate their partners in average span of 9 months from the time of surgery.

Conclusion: In our experience, microsurgical subinguinal varicocelectomy has improved the semen analysis after 3 months with a 30% chance of impregnation at an average span of 9 months, postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomy facilitated better identification of the testicular arteries.

Philippine Journal of Urology, 2012

ABSTRACT This is a case of E. M., a 62 years old, post kidney transplant, post appendectomy, and... more ABSTRACT
This is a case of E. M., a 62 years old, post kidney transplant, post appendectomy, and post sigmoidectomy male patient, who was diagnosed with prostate adenocarcinoma, confirmed by TRUS-guided prostate biopsy. PSA was 6. Serum creatinine, CBC, electrolytes and urinalysis were normal. DRE showed a soft, smooth prostate without nodules. Nerve sparing radical retropubic prostatectomy was done. Limitations and advantages of the surgical technique with modifications of the standard surgical technique were discussed in this unique clinical situation.
Keywords: prostate cancer, kidney transplantation, radical retropubic prostatectomy, nerve sparing procedure

Objectives: To present a modified microdot technique of microsurgical vasovasostomy that facilita... more Objectives: To present a modified microdot technique of microsurgical vasovasostomy that facilitates precise suture placement. To determine the outcome of a multilayer microsurgical vasovasostomy (VV) employing the modified microdot technique in terms of patency and pregnancy rate.

Introduction and Objectives: Obstructive azoospermia is defined as the absence of spermatozoa in ... more Introduction and Objectives: Obstructive azoospermia is defined as the absence of spermatozoa in the ejaculate despite normal spermatogenesis. In the modern era of assisted reproductive technology, infertile male patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection (ICSI). Vasal repair, either vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural pregnancy. Little data on long-term outcomes for microscopic reconstruction exist. Therefore, the objective of this study is to evaluate the outcomes and complications of microsurgical reconstruction of the male ductal system in the Philippines setting.

Materials and Methods: This is a retrospective study of 136 post-vasectomy patients who underwent microsurgical reconstruction from 2001–2019. Patients underwent microsurgical vasectomy reversal. Outcomes such as patency rate and pregnancy rate were documented and analyzed.

Results: One hundred and thirty six patients underwent microsurgical vasectomy reversal. Ninety one patients underwent bilateral microsurgical vasovasostomy. Forty one patients underwent combined microsurgical vasovasostomy and vasoepididymostomy. Three patients underwent bilateral vasoepididymostomy and one crossed microsurgical vasoepididymostomy (left to right). Four patients had no child, 66 patients had 1 child, 34 patients had 2 children, 29 had 3 children and 3 patients had 4 children prior to vasectomy. Age of wife was between 20 to 32 years old. Mean interval from vasectomy was 9 years. Vas deferens were patent in 103 (76%) of patients. Clinical pregnancy with successful delivery was achieved in 87 (64%) patients. There were only three who had postoperative hematoma (2%) and one developed surgical site infection (0.7%).

Conclusion: Microsurgical reconstruction of the male ductal system is a good option in infertile male with obstructive azoospermia to achieve clinical pregnancy in post vasectomy patients and with minimal complications. The study confirms the effectiveness of male infertility microsurgery for vasectomized men who wish to father children.

Drafts by Dennis Lusaya

Model Microsurgical Training using Mobile Devices Miguel Karlo R. Galut, M.D., Dennis G. Lusaya, ... more Model Microsurgical Training using Mobile Devices
Miguel Karlo R. Galut, M.D., Dennis G. Lusaya, M.D, FPUA, FPCS
Department of Surgery, Section of Urology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines

Objectives/s: To develop a model microsurgical training program that can be done at home to teach and improve microsurgical suturing skills using mobile devices
Materials and Methods: 10 surgical residents were given preparatory materials for microsurgical suturing. The residents were given microsurgical instruments, a mounting accessory, a mobile device, 6-0 sutures, 10-0 sutures, and an improvised suturing pad made up of cut surgical latex gloves. The residents used a mobile device with recording capacity for magnification. The residents used 6-0 suture for the first 2 weeks, making 5 surgical knots on the first week and 10 surgical knots on the second week. The residents subsequently used 10-0 suture for the last 2 weeks, making 5 surgical knots for the third week and 10 knots for the fourth week. The videos were sent to an expert evaluator who rated the quality of suturing using the SMART scale
Results: A significant improvement in the SMART score of residents were noted between weeks 1 and 2. A significant improvement was also noted between weeks 1 and 4. No significant improvement was noted between weeks 3 and 4.
Conclusion: The authors developed a home-based model microsurgical training program that can teach and improve microsurgical suturing skills using mobile devices.

Background. Multiple factors have been associated with non-obstructive azoospermia, but results f... more Background. Multiple factors have been associated with non-obstructive azoospermia, but results from different studies are conflicting. Predictive factors for successful surgical sperm retrieval may help in counseling patients and also optimize outcome among patients who will undergo sperm retrieval. Methods. Data were collected data from 223 consecutive patients who underwent conventional or microsurgical testicular sperm extraction (TESE) from August 2011 to January 2021 under two urologists of the center. Data regarding age, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol, testicular size, histopathology, surgical technique, and sperm retrieval were collected. Patients with obstructive azoospermia, repeated TESE procedure, and those who underwent TESE for oncofertility were excluded. Using simple logistic regression analysis, the relationship of the different factors to successful sperm retrieval was computed as odds ratio. Results. The overall surgical sperm retrieval rate was found to be 65.71%. The odds ratio were 1.04 (95% CI 1.00-1.09) for age, 0.94 (95% CI 0.91-0.97) for FSH, 0.93 (95% CI 0.87-0.99) for LH, 1.24 (95% CI 0.99-1.55) for testosterone, and 0.93 (95% CI 0.88-0.98) for estradiol. Decreased testicular size was also associated significantly with sperm retrieval (OR 0.22, 95% CI 0.09-0.56). Histopathologic pattern and surgical technique were also significantly associated with successful sperm retrieval.

Medical & Surgical Urology, 2015

Philippine Journal of Urology, 2019

Endourology Progress, 2019

Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no ... more Percutaneous nephrolithotomy (PCNL) is the standard of care for large renal calculi which are no longer suitable for extracorporeal shockwave lithotripsy. The key to success depends on the urologist’s choice of instruments, preoperative and intraoperative access planning, patience, perseverance, skill and training. Percutaneous renal access is a crucial early step that may ultimately influence outcomes of PCNL in terms of overall stone-free rate and complications. Several techniques for access and tract dilatation are described in this chapter. Prone, supine or lateral positioning during renal access have inherent advantages and disadvantages. Similarly, various adjunct imaging modalities and instrumentation are available to increase success and decrease the risk of complications. Nonetheless, the most practical and effective approach still depends heavily on stone burden and renal anatomy, available instrumentation and equipment, and the surgeon’s expertise and level of training.

Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most pat... more Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Most patients present with hematuria, suprapubic pain and dysuria. Presented is a case of a 44 year old male with 4 month history of hematuria and terminal dysuria who underwent radical cystoprostatectomy with histopathology findings of mucinous adenocarcinoma. Upon diagnosis, 25% of patients have distant metastases and 50% have stage IV disease with 50% five years survival rate for stage I-III tumor with no stage IV patients surviving beyond two years. Hence, for this type of cancer, early diagnosis is crucial. Surgery is the mainstay of treatment and is resistant with chemotherapy and radiation. Thus, for patient with confirmed or highly suspicious mucinous adenocarcinoma of the bladder, timely radical resection is warranted.

This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms a... more This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms and an elevated prostate specific antigen (PSA) of 48.21ng/ml. Multiparametric MRI of the prostate revealed a markedly enlarged prostate (225grams) with a PIRADS 5 lesion at the left posterior peripheral zone. Prostate biopsy done revealed prostate adenocarcinoma Gleason 7(3+4). Metastatic workup was negative for distant metastasis hence the patient was advised robot-assisted laparoscopic prostatectomy (RALP). Several difficulties were encountered during the surgical technique. The usual posterior approach was not feasible because incising the peritoneum over the rectovesical pouch would not be able to expose the vas deferens and seminal vesicles. An anterior approach was instead done, but this was still difficult due to the lack of space for proper exposure and movement of instruments. The posterior dissection was also challenging; three successive suspension stitches were necessary in o...

World Journal of Urology, 1995

Continuing experience with the use of Nd: YAG laser-fibre prostatectomy over the past 4 years has... more Continuing experience with the use of Nd: YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months

Journal of the American College of Surgeons, 2014

World Journal of Urology, 1995

Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has ... more Continuing experience with the use of Nd:YAG laser-fibre prostatectomy over the past 4 years has produced encouraging results. Of the 198 patients we treated with the 60-W/60-s technique, 74 were available for evaluation after undergoing laser ablation of the prostate between October 1990 and July 1994. In all, 29/74 and 9/74 patients were available for 24 and 36 months of follow-up, respectively. The American Urological Association (AUA) symptom scores, peak uroflow (Qmax) rates and post-void residual urinary volumes show marked improvement. Following laser ablation of the prostate (LAP), complications have included 16 patients with post-procedural recurrent obstructive symptoms requiring revision. Three patients developed urinary tract infection, two developed bladder-neck stenosis, four fully anticoagulated patients with clot retention required blood transfusion and three patients had epididymo-orchitis. The results show a sustained reduction in AUA symptom scores and maintained improvement in peak flow rates and residual volumes, with stabilization of the above-mentioned parameters occurring within 12-36 months. The results demonstrate the continued durability of the outcome of LAP.

Journal of Endourology, 1994

Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-p... more Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-prototype visual urethrotome was evaluated for the management of submucosal vesicoureteral stones and as an aid in the removal of a Dormia basket with an entrapped stone impacted in the submucosa of the vesical portion of the ureter. A total of 14 male and 11 female adult patients were included. Fifteen patients required ureteral meatotomy to release the stone. Transurethral ureteral meatotomy is a precise and safe procedure associated with minimal complications when carefully done. Our local-prototype instrument proved to be a simple, economical, and valuable tool.

Journal of Endourology, 1995

Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has sh... more Continuing experience with Nd:YAG noncontact sidefiring laser fibers over the past 4 years has shown encouraging results. Thus far, of the 198 patients treated with the 60 W/60 seconds technique since October 1990, a total of 74 were available for long-term evaluation (69 at 12 months and 29 at 24 months). The AUA Symptom Scores, Qmax (peak uroflow rates), and postvoiding residual urine volumes demonstrated marked improvement. The complications included 16 instances of recurrent obstructive symptoms necessitating revision. Three patients suffered urinary tract infections, two patients developed bladder neck stenosis, four anticoagulated patients with clot retention required blood transfusions, and three patients had epididymoorchitis. Follow-up at 12 and 24 months showed sustained reduction in AUA Symptom Scores and maintained improvement of the peak flow rates and residual volumes. These results demonstrate the safety and clinical applicability of laser ablation of the prostate and its potential usefulness as a less invasive therapy for benign hyperplasia.

Current Opinion in Urology, 1994

Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its... more Abstract Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its ability to ablate hyperplastic tissue successfully. This therapy has emerged to challenge transurethral resection of the prostate (TURP), considered to be the'gold standard'of ...

Microsurgical Subinguinal Varicocelectomy for Male Infertility Jonathan Mendoza, MD Urology Resi... more Microsurgical Subinguinal Varicocelectomy for Male Infertility

Jonathan Mendoza, MD
Urology Resident
Institute of Urology
St. Luke’s Medical Center, QC
Philippines

Dennis G. Lusaya, MD FPUA, FPCS
Chairman Institute of Urology
St. Luke’s Medical Center, Quezon City
Associate Professor. Department of Surgery/Urology
University of Santo Tomas, Manila, Philippines

ABSTRACT

Introduction: Varicoceles represent the most common attributable cause of primary and secondary infertility in the male. A number of studies have established the effect of performing varicocelectomy in order to improve semen parameters. Several techniques of varicocelectomy has been described in literature, however, the microsurgical technique has been considered as the gold standard in doing this procedure.
Objective/s: The study primarily aims to establish the effect of microsurgical varicocelectomy on post-operative semenalysis when compared to baseline semenalysis. We also aim to establish the impregnation rate and the span at which impregnation occur following varicocelectomy. Lastly, we describe our technique and modifications of microsurgical subinguinal varicoelectomy performed by a single surgeon using an operating microscope and microdoppler throughout the procedure.
Materials and Methods: Microsurgical subinguinal varicocelectomy was performed on 37 patients in our institution from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade, operative time, intraoperative findings, postoperative complication, and 3-month follow-up semenalysis results were recorded and compared. Successful impregnation of the partner and the number of months from the operation to the successful impregnation were also recorded.
Results: Three months postoperative semenalysis parameters were compared to the baseline semenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60, postoperatively with p-value of 0.010. There was no significant difference observed in the total count, concentration, and percent immature forms. Eleven or 30% ofpatients were able to successfully impregnate their partners in average span of 9 months from the time of surgery.

Conclusion: In our experience, microsurgical subinguinal varicocelectomy has improved the semen analysis after 3 months with a 30% chance of impregnation at an average span of 9 months, postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomy facilitated better identification of the testicular arteries.

Philippine Journal of Urology, 2012

ABSTRACT This is a case of E. M., a 62 years old, post kidney transplant, post appendectomy, and... more ABSTRACT
This is a case of E. M., a 62 years old, post kidney transplant, post appendectomy, and post sigmoidectomy male patient, who was diagnosed with prostate adenocarcinoma, confirmed by TRUS-guided prostate biopsy. PSA was 6. Serum creatinine, CBC, electrolytes and urinalysis were normal. DRE showed a soft, smooth prostate without nodules. Nerve sparing radical retropubic prostatectomy was done. Limitations and advantages of the surgical technique with modifications of the standard surgical technique were discussed in this unique clinical situation.
Keywords: prostate cancer, kidney transplantation, radical retropubic prostatectomy, nerve sparing procedure

Objectives: To present a modified microdot technique of microsurgical vasovasostomy that facilita... more Objectives: To present a modified microdot technique of microsurgical vasovasostomy that facilitates precise suture placement. To determine the outcome of a multilayer microsurgical vasovasostomy (VV) employing the modified microdot technique in terms of patency and pregnancy rate.

Introduction and Objectives: Obstructive azoospermia is defined as the absence of spermatozoa in ... more Introduction and Objectives: Obstructive azoospermia is defined as the absence of spermatozoa in the ejaculate despite normal spermatogenesis. In the modern era of assisted reproductive technology, infertile male patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection (ICSI). Vasal repair, either vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural pregnancy. Little data on long-term outcomes for microscopic reconstruction exist. Therefore, the objective of this study is to evaluate the outcomes and complications of microsurgical reconstruction of the male ductal system in the Philippines setting.

Materials and Methods: This is a retrospective study of 136 post-vasectomy patients who underwent microsurgical reconstruction from 2001–2019. Patients underwent microsurgical vasectomy reversal. Outcomes such as patency rate and pregnancy rate were documented and analyzed.

Results: One hundred and thirty six patients underwent microsurgical vasectomy reversal. Ninety one patients underwent bilateral microsurgical vasovasostomy. Forty one patients underwent combined microsurgical vasovasostomy and vasoepididymostomy. Three patients underwent bilateral vasoepididymostomy and one crossed microsurgical vasoepididymostomy (left to right). Four patients had no child, 66 patients had 1 child, 34 patients had 2 children, 29 had 3 children and 3 patients had 4 children prior to vasectomy. Age of wife was between 20 to 32 years old. Mean interval from vasectomy was 9 years. Vas deferens were patent in 103 (76%) of patients. Clinical pregnancy with successful delivery was achieved in 87 (64%) patients. There were only three who had postoperative hematoma (2%) and one developed surgical site infection (0.7%).

Conclusion: Microsurgical reconstruction of the male ductal system is a good option in infertile male with obstructive azoospermia to achieve clinical pregnancy in post vasectomy patients and with minimal complications. The study confirms the effectiveness of male infertility microsurgery for vasectomized men who wish to father children.

Model Microsurgical Training using Mobile Devices Miguel Karlo R. Galut, M.D., Dennis G. Lusaya, ... more Model Microsurgical Training using Mobile Devices
Miguel Karlo R. Galut, M.D., Dennis G. Lusaya, M.D, FPUA, FPCS
Department of Surgery, Section of Urology, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines

Objectives/s: To develop a model microsurgical training program that can be done at home to teach and improve microsurgical suturing skills using mobile devices
Materials and Methods: 10 surgical residents were given preparatory materials for microsurgical suturing. The residents were given microsurgical instruments, a mounting accessory, a mobile device, 6-0 sutures, 10-0 sutures, and an improvised suturing pad made up of cut surgical latex gloves. The residents used a mobile device with recording capacity for magnification. The residents used 6-0 suture for the first 2 weeks, making 5 surgical knots on the first week and 10 surgical knots on the second week. The residents subsequently used 10-0 suture for the last 2 weeks, making 5 surgical knots for the third week and 10 knots for the fourth week. The videos were sent to an expert evaluator who rated the quality of suturing using the SMART scale
Results: A significant improvement in the SMART score of residents were noted between weeks 1 and 2. A significant improvement was also noted between weeks 1 and 4. No significant improvement was noted between weeks 3 and 4.
Conclusion: The authors developed a home-based model microsurgical training program that can teach and improve microsurgical suturing skills using mobile devices.

Background. Multiple factors have been associated with non-obstructive azoospermia, but results f... more Background. Multiple factors have been associated with non-obstructive azoospermia, but results from different studies are conflicting. Predictive factors for successful surgical sperm retrieval may help in counseling patients and also optimize outcome among patients who will undergo sperm retrieval. Methods. Data were collected data from 223 consecutive patients who underwent conventional or microsurgical testicular sperm extraction (TESE) from August 2011 to January 2021 under two urologists of the center. Data regarding age, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol, testicular size, histopathology, surgical technique, and sperm retrieval were collected. Patients with obstructive azoospermia, repeated TESE procedure, and those who underwent TESE for oncofertility were excluded. Using simple logistic regression analysis, the relationship of the different factors to successful sperm retrieval was computed as odds ratio. Results. The overall surgical sperm retrieval rate was found to be 65.71%. The odds ratio were 1.04 (95% CI 1.00-1.09) for age, 0.94 (95% CI 0.91-0.97) for FSH, 0.93 (95% CI 0.87-0.99) for LH, 1.24 (95% CI 0.99-1.55) for testosterone, and 0.93 (95% CI 0.88-0.98) for estradiol. Decreased testicular size was also associated significantly with sperm retrieval (OR 0.22, 95% CI 0.09-0.56). Histopathologic pattern and surgical technique were also significantly associated with successful sperm retrieval.