Vasectomy reversal in humans

Abstract

Vasectomy is the most common urological procedure in the United States with 18% of men having a vasectomy before age 45. A significant proportion of vasectomized men ultimately request vasectomy reversal, usually due to divorce and/or remarriage. Vasectomy reversal is a commonly practiced but technically demanding microsurgical procedure that restores patency of the male excurrent ductal system in 80-99.5% of cases and enables unassisted pregnancy in 40-80% of couples. The discrepancy between the anastomotic patency rates and clinical pregnancy rates following vasectomy reversal suggests that some of the biological consequences of vasectomy may not be entirely reversible in all men. Herein we review what is known about the biological sequelae of vasectomy and vasectomy reversal in humans, and provide a succinct overview of the evaluation and surgical management of men desiring vasectomy reversal.

Figure 1. (A) Schematic representing re-approximation of vasal mucosa as part of a 4-layer closure using 10–0 nylon sutures with the microdot technique. (B) Intraoperative vasovasostomy repair – note the microdots spaced approximately 20 µm in diameter.

Figure 2. (A) Schematic demonstrating a vasoepididymostomy using a longitudinal intussuscepted technique with 10–0 sutures to intussuscept a longitudinally incised segment of the epididymal tubule into the lumen of the abdominal vasal remnant. The intussusception is then reinforced with multiple 9–0 and 8–0 sutures. (B) Intraoperative vasoepididymostomy using 10–0 sutures.