Modified one-layer microsurgical vasovasostomy in vasectomized patients

Abstract

Bilateral vasovasostomies were performed in 7 previously vasectomized patients. The method employed was a modification of a one-layer anastomotic technique. There was no correlation between the presence of absence of sperm in the vas fluid, presence or absence of sperm granuloma, and site of vasectomy. No correlation was revealed between the presence or absence of sperm in the vas fluid and the duration of obstructive period. After vasovasostomy, sperm was observed in the ejaculate in 86% of the patients. Only one patient's partner became pregnant. However, the partner of one patient with short postoperative period and good seminal finding after vasovasostomy was expected to become pregnant. This modified method of one-layer microsurgical vasovasostomy can be performed more easily and quickly, but requires further clinical experience and evaluation of usefulness.

PIP: For various reasons, some men seek the reversal of prior vasectomy. Macroscopic methods to reverse vasectomy and restore fertility have achieved patency rates of 50% or higher, but reports have also indicated that final fertility is attained in only 5-25% of cases. Higher patency and pregnancy rates have been reported using a two-layer microscopic technique. This paper reports the findings obtained after performing a modification of a one-layer microsurgical vasovasostomy. Bilateral vasovasostomies were performed in seven patients vasectomized 2-12 years before; the median interval between vasectomy and vasectomy reversal was 9 years. The men were aged 33-45 years (median age, 39 years). No correlation was identified between the presence or absence of sperm in the vas fluid, presence or absence of sperm granuloma, and site of vasectomy. Furthermore, no correlation was revealed between the presence or absence of sperm in the vas fluid and the duration of obstructive period. After vasovasostomy, sperm was observed in 86% of the patients, although only one patient's partner became pregnant. The partner of one patient with short postoperative period and good seminal finding after vasovasostomy is, however, expected to become pregnant. The authors note that while the modified method of one-layer microsurgical vasovasostomy can be performed easier and quicker than the two-layer approach, it requires a higher level of clinical experience and additional evaluation of its usefulness.