Failed Vasectomy Reversal: Is a Further Attempt Worthwhile Using Microsurgery?

Vasectomy reversal

“…With increasing numbers of men undergoing vasectomy reversal procedures, it is important for the surgeon to be prepared to properly advise patients about the management of a failed procedure. It has been generally accepted that repeat microscopic reconstruction is worthwhile in failed vasectomy reversal cases 19,20 . However, the choice between a vasovasostomy and an epididymovasostomy is still controversial, but the latter may be required when sperm are absent from the intra‐operative vas deferens fluid at the testicular end of the vas deferens.…”

“…However, the actual live‐birth rate following ICSI is about 15–35%, despite varying reports from various institutions 27–29 . This is not a vastly different outcome compared with the results expected from a series of repeat vasectomy reversals performed by skilled microsurgeons 6,19–22 . Also, when one considers the additional cost and the possibility of repeated surgery in order to obtain sperm from ICSI, microscopic epididymal sperm aspiration (MESA) ICSI or testicular sperm extraction (TESE) ICSI, it has been shown that these techniques cannot completely replace repeat vasectomy reversal in the management of failed vasectomy reversal patients.…”

Microscopic Vasectomy Reversal 30 Years Later: A Summary of 4010 Cases by the Same Surgeon

“…Later attempts in the 1990s to use stents to improve success rates of vasovasostomy without having to resort to accurate microsurgical anastomosis have also failed (Rothman et al, 1997). The literature on this issue can be very confusing because of the relatively small number of patients (often less than 30) in most published series (Middleton et al, 1987; Fox, 1994, 1997; Matsuda et al, 1994; Witt et al, 1994; Chiang 1996; McDonald, 1996; Yamamoto et al, 1997; Carbone et al, 1998; Inaba et al, 1999; Jokelaine et al, 2001; Schrepferman et al, 2001; Huang et al, 2002).…”

Current practice in the management of vasectomy reversal and unobstructive azoospermia in Merseyside & North Wales: a questionnaire‐based survey

“…Urologists were also more likely to use a microscopic technique than were general surgeons (Table 1). This may reflect different referral practice, with more patients being referred after a previous failed reversal, where there is evidence that further surgery using microsurgical techniques is indicated [31]. However, significantly more urologists also stated that they would consider referring patients for surgical sperm retrieval after a previous failed vasectomy reversal.…”