MRI of the Epididymis: Can the Outcome of Vasectomy Reversal Be Predicted Preoperatively?

Abstract

Increased epididymal T1 signal intensity (likely due to proteinaceous material lodged within the epididymal tubules) at preoperative MRI in patients undergoing vasectomy reversal suggests vasal/epididymal tubular occlusion and requirement for vasoepididymostomy rather than vasovasostomy.

Diffusion‐Weighted and Magnetization Transfer Imaging in Testicular Spermatogenic Function Evaluation: Preliminary Results

“…Pelvic MRI was performed on all subjects in the supine position after urination using a 3T MR system (Magnetom Trio, Siemens Medical Solutions, Erlangen, Germany) with an 8‐channel phased‐array pelvic coil. With a small towel between the two thighs to stabilize the testes and the penis taped to the anterior abdominal wall, axial and coronal fast spin‐echo T 2 ‐weighted ( T 2 W, repetition time / echo time [TR/TE]: 4380–5500/73–76 msec) and axial spin‐echo T 1 ‐weighted ( T 1 W, 600–653/13 msec) images were obtained . An additional fat‐suppressed axial T 1 W sequence was acquired when T 1 hyperintense foci were detected in the testes.…”

“…With a small towel between the two thighs to stabilize the testes and the penis taped to the anterior abdominal wall, axial and coronal fast spin-echo T 2 -weighted (T 2 W, repetition time / echo time [TR/TE]: 4380-5500/73-76 msec) and axial spin-echo T 1 -weighted (T 1 W, 600-653/13 msec) images were obtained. [12][13][14][15] An additional fat-suppressed axial T 1 W sequence was acquired when T 1 hyperintense foci were detected in the testes. DWI was performed with free-breathing, water-excited axial single-shot spin-echo echo-planar imaging (TR/TE, 8500/ Axial 2D Flash T 1 W sequences (TR, 371 msec; TE, 2.83 msec; flip angle, 308; number of signals averaged, 2) without and with magnetization transfer (MT) off-resonance RF pulse (bandwidth, 300 HZ/px; frequency, 1200 Hz) were acquired.…”

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade

“…Previous studies have determined the predictors for performing a VE. Table summarizes these factors that have been reported over the last 10 years …”

“…The hypothesis was that sperm production is impaired by prolonged obstruction and that protective mechanisms ameliorate epididymal “blowout.” Another study reported other factors that predict the need for a VE, including the patient's age (odds ratio: 1.11) and repeat VRs (odds ratio: 5.78) . An increased epididymal T1 signal intensity on the preoperative magnetic resonance imaging suggests vassal or epididymal tubular occlusion and the need for a VE rather than a VV …”

Vasectomy in Male Contraception and its Reversal

“…Increased epididymal T1 signal intensity on preoperative magnetic resonance imaging (MRI) in patients before vasectomy reversal also suggests epididymal tubular occlusion and the need for EV. These patients often have tubular ectasia on sonography and an epididymal MRI can be useful [45]. The absence of effluent or poor-quality effluent without any recognizable sperm parts is consistent with obstruction of the proximal vas and an EV should then be considered.…”