Editorial Comment: Vasectomy re-reversal: effectiveness and parameters associated with its success

Abstract

Every year 500,000 men undergo a vasectomy in the United States. Around 2% to 6% will reverse the procedure, seeking a new conception, usually as a result of a new relationship (1,2). But, what to do when the vasectomy reversal fails? We know that the time between vasectomy and reversal surgery is crucial. The Vasovasostomy Study Group showed patency and pregnancy rates of 97% and 76%, respectively, for the 3-year obstruction interval, which dropped to 71% and 30% for the 15-year obstruction interval or more (3). Achieve a spontaneous pregnancy after a re-reversing the vasectomy is something challenging and that's exactly what the article in question is about. In these cases, in which the reversal fails and the patient seeks spontaneous pregnancy, the only way is a vasectomy re-reversion, a new microsurgical procedure performed after the first reversal. In this topic, aiming to offer quality information leading to the best clinical decision, what are the parameters capable of influencing the success rate of a vasectomy re-reversal (4)? We will see below.There is time that the scientific community has concerned if microsurgical vasovasostomy and vasoepididymostomy provided satisfactory patency rate and natural pregnancy rates for patients with a previous failed vasectomy reversal (5). In this interesting pleasant reading article, the authors raise a topic that still lacks robust data: Vasectomy re-reversion (6). A first interesting aspect that worth mentioning is the parameters used to define the reversal failure. The authors were careful to highlight that the failure is defined as a persistent postoperative azoospermia, or a good sperm concentration with very little or even no motility and / or associated with necrozoospermia. This is important because the final and true desire is conception and, therefore, these criteria are of great importance when we consider the functionality of the sperm resulting from re-reversion. Using a simple and clear methodology, the authors present the study with a total of 18 patients, with the objective of determining the factors associated with the success of the vasectomy re-reversion. For this, the patient´s age at the time of the reversion, time between the vasectomy and the vasectomy reversal, time between the vasectomy reversal and the vasectomy re-reversal, the presence of sperm in the proximal deferens fluid and results of seminal analysis after vasectomy re-reversion were analyzed.Before we reach the important conclusions, some aspects need to be highlighted, seeking to clarify other aspects involved in the reversal or re-reversion of the vasectomy. The first would be the surgeon's experience. The greater the number of procedures, the greater the success rate. We felt the absence of comments in this regard. Another important aspect is about the chosen technique: the authors made it clear in the methodology that the suture was performed in a single plane with 9-0 nylon but nothing was treated about the number of "stitches". Most surgeons today choose 4 single layer sutu-

O Impacto do tempo de vasectomia na qualidade dos espermatozoides obtidos por aspiração percutânea de espermatozoides do epidídimo (PESA) para tratamento de reprodução assistida

“…Apesar de ser destinada à esterilização permanente, e a maioria dos homens desde a vasectomia tenha certeza da escolha da contracepção cirúrgica 3 , cerca de 4 a 6% desejarão posteriormente reverter a vasectomia, buscando uma nova concepção, geralmente em decorrência de um novo relacionamento, mudança no estado civil ou por objetivos reprodutivos 4 . Nesses casos, as opções de tratamento incluem reconstrução microcirúrgica do trato seminal e Injeção Intracitoplasmática de Espermatozoides (ICSI) 5 .…”