Vasectomy reversal — microsurgery for best results

Fox, Miles

doi:10.1111/j.1464-410x.1994.tb07613.x

Cited by 56 publications

(43 citation statements)

References 13 publications

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“…The denervation of the vas deferens during the vasectomy may halt the peristaltic propulsion of sperm through the anastomosis. Our results, with a 75% patency rate for the vasectomy with conventional suture and an 80% patency rate for the vasectomy with fibrin glue, agree with the literature that reports a 80 to 90% patency rate (5)(6)(7)(8)(10)(11)(12)26).…”

Section: Commentssupporting

confidence: 82%

“…Initially, the controversy was about the use of sutures in one or two layers. The analysis of these two possibilities in the literature shows similar results with respect to fertility and patency rates (8,10,21,22). The fundamental difference is related to operative time, required training and costs.…”

Section: Commentssupporting

confidence: 56%

“…Several techniques using microanastomosis show good results, with respect to both anastomosis patency and pregnancy rate, between 80 to 90%, and 50 to 80%, respectively (5)(6)(7)(8)(9)(10)(11). Thus, the main objective of this study is to devise a new technique or to improve an existing one that would allow a faster procedure (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats

Busato

Marquetti²,

Rocha

2007

Int. braz j urol.

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Objective: Microsurgical procedures are currently the gold standard for vasovasostomy with excellent results, but it takes an increased operative time demanding special training and experience in microsurgery. The objective of this study is to reach the same results with reduced operative time. Materials and Methods:Male adults Wistar rats were divided into 3 groups: I) 20 rats in control group, II) 20 with conventional one-layer microsuture and III) 20 with fibrin glue. After four weeks each rat was left for two weeks with two female rats. Results: The fertility rates were 80% in group I, 70% in group II and 65% in group III (p > 0.05). In group II granuloma was found in 75% of the rats, while in group III in 85% (p < 0.05). Anastomosis was considered with patency in 75% and 80% of the rats in groups II and III (p > 0.05). Overall operative time was 41.7 ± 2.49 and 28.55 ± 1.14 minutes in groups II and III (p < 0.05) and the time to anastomosis of 24.6 ± 1.8 and 9.35 ± 0.78 minutes (p < 0.05), respectively. Conclusions: We can conclude that vasovasostomy with fibrin adhesive has the same results of the conventional microsurgery technique but with a reduced operative time and a simplified procedure.

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Section: Commentssupporting

confidence: 82%

Section: Commentssupporting

confidence: 56%

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Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats

Busato

Marquetti²,

Rocha

2007

Int. braz j urol.

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“…The technique used was that previously described [8,12]; in summary, through a scrotal approach the vas is located and freed just above and below the level of the previous anastomosis, and transected with a scalpel, obliquely at the abdominal end. A narrow lachrymal probe is used to gently dilate the lumen into which a 5±8 cm length of 3/0 Nylon is passed in the abdominal direction.…”

Section: Methodsmentioning

confidence: 99%

Failed vasectomy reversal: is a further attempt using microsurgery worthwhile?

Fox

2000

BJU International

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Objective To determine, in failed vasectomy reversal, the usefulness of a revised anastomosis using microsurgery in achieving sperm in the ejaculate and fertility, and to relate the outcome to the site of the anastomosis, length of time from vasectomy, and presence or absence of sperm in the vas at surgery. Patients and methods In a series of 28 patients with con®rmed anastomotic obstruction undergoing vasectomy reversal (over a 10-year period), a microsurgical technique using an oblique end-to-end two-layer interrupted anastomosis with 10/0 Nylon was used to establish vasal continuity. Subsequent seminal analysis at 3±6 months and ensuing paternity were related to several variables. The results were compared with those obtained after 137 cases of primary microsurgical vasovasostomy. Results Sperm was restored to the ejaculate in 16 (57%) of the patients and successful fertilization was reported in nine (32%). The interval between vasectomy and reversal surgery was relevant to the outcome, with four out of four men having sperm in the ejaculate within 5 years and three achieving paternity. However, the fertility rate was still moderate after an interval of 6±10 years (two of six) and at >10 years (four of 18). The presence of sperm in the ejaculate was related to whether or not sperm were found in the testicular end of the vas at operation, but absence did not preclude a successful outcome. The overall results were not signi®cantly different from those after primary microsurgical reversal surgery. Conclusion Microscopic vasovasostomy after previous obstructive failure provides the patient with a further reasonable chance of becoming fertile; although diminishing with time from vasectomy, even after a prolonged period there can be success.

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“…This procedure is performed by creating a vasovasostomy (VV) or vasoepididymostomy (VE) and higher success rates are found with microsurgical technique (Fox, 1994). VE is a technically challenging procedure and is recommended if epididymal obstruction is suspected.…”

Section: Introductionmentioning

confidence: 99%

Pre‐operative risk factors associated with need for vasoepididymostomy at the time of vasectomy reversal

Fuchs

Anderson

Ostrowski³

et al. 2015

Andrology

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SUMMARYThe absence of sperm in the ejaculate after vasectomy reversal is commonly caused by failure to recognize and subsequently bypass epididymal or proximal vasal obstruction at the time of vasectomy reversal. If intra-operative proximal obstruction is suspected, vasoepididymostomy (VE) is recommended rather than vasovasostomy (VV). We sought to calculate the associated risk of needing VE, rather than VV with time from original vasectomy (obstructive interval) using a large cohort of vasectomy reversal patients. We reviewed the electronic and paper vasectomy reversal database by a single surgeon from 1978 through 2012. We performed univariate analysis to identify variables that predicted the need for VE rather than VV, and then combined only significant univariates into our multi-variable analysis. 2697 total men underwent vasectomy reversal, and 239 were repeat procedures. Of the 5296 individual testes operated on, 1029 were VE. Significant variables that predicted the need for VE on univariate analysis included: age, obstructive time interval, vasectomy reversal after previous VV (repeat vasectomy reversal), and year the procedure was performed. On multi-variable analysis significant risk factors for VE were age above 50 (OR 1.36), repeat vasectomy reversal (OR 5.78), and greater obstructive time interval (OR 1.56). For every 3 years since original vasectomy, the risk of needing VE increases by 56%. There is a linear relationship between obstructive interval and need for VE. Men undergoing repeat vasectomy reversal have five times greater risk of requiring VE and men greater than 50 years of age are also at higher risk. Using these pre-operative predictors is helpful in identifying patients who will benefit from referral to an experienced surgeon who can perform VE.

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Vasectomy reversal — microsurgery for best results

Abstract: The additional time and effort required for a microsurgical approach to vasovasostomy were worthwhile to obtain patency and fertility rates which were superior to those of other techniques.

Cited by 56 publications

References 13 publications

Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats

Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats

Failed vasectomy reversal: is a further attempt using microsurgery worthwhile?

Pre‐operative risk factors associated with need for vasoepididymostomy at the time of vasectomy reversal

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