Outcomes of Microsurgical Vasovasostomy for Vasectomy Reversal: A Meta-analysis and Systematic Review

Herrel, Lindsey A.; Goodman, Michael; Goldstein, Marc; Hsiao, Wayland

doi:10.1016/j.urology.2014.12.023

Cited by 63 publications

(40 citation statements)

References 15 publications

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“…The Vasovasostomy Study Group found no statistical difference in patency or pregnancy outcomes for two-layer and single-layer VVs (7). These early results were subsequently corroborated by a meta-analysis involving 6,633 patients (16). Presumably, a high-quality single-layer anastomosis will prevent sperm extravasation and the accompanying risk of granuloma.…”

Section: Vasovasostomymentioning

confidence: 80%

“…Contemporary series examining the impact of obstructive interval have been less clear in terms of significance (14,15). However, the preponderance of data suggests that the obstructive interval remains one of the more robust pieces of data for preoperative counseling (16). Another traditional sign useful in the preoperative setting is the presence of a sperm granuloma.…”

Section: Preoperative Evaluation Male Factormentioning

confidence: 99%

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Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation

Hayden

Goldstein

2019

Fertility and Sterility

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Men seeking fertility after elective sterilization can be treated with a wide array of interventions. Reconstruction of the reproductive tract remains the gold standard and most cost-effective option for the appropriately selected candidate. In the following review, the treatment algorithm for men desiring vasectomy reversal is outlined. Specifically, the current evidence basis for preoperative evaluation, intraoperative decision making, postsurgical management, and emerging advances to optimize outcomes will be discussed. Finally, the important role of microsurgical training and how the field can improve quality of care will be reviewed. (Fertil Steril Ò 2019;111:444-53. Ó2019 by American Society for Reproductive Medicine.

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Section: Vasovasostomymentioning

confidence: 80%

Section: Preoperative Evaluation Male Factormentioning

confidence: 99%

Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation

Hayden

Goldstein

2019

Fertility and Sterility

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“…An ideal vasovasostomy procedure requires precise mucosal approximation with a watertight anastomosis. Although the 2-layer microsurgical approach remains the gold standard in vasovasostomy [ 9 10 ], other researchers have reported no difference in patency when comparing modified 1-layer to 2-layer anastomoses [ 10 11 ]. Herrel et al [ 11 ] conducted a review of 31 English-language articles describing the results of microscopic vasovasostomy and reported a mean postoperative patency of 89.4%.…”

Section: Discussionmentioning

confidence: 99%

Loupe-Assisted Vasovasostomy Using a Prolene Stent: A Simpler Vasectomy Reversal Technique

Jeon

Kwon

Park

et al. 2017

World J Mens Health

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PurposeMicrosurgical vasovasostomy is associated with high patency and pregnancy rates, but is difficult and requires significant effort and time to learn. Therefore, we assessed a simplified loupe-assisted vasovasostomy method using a Prolene stent.Materials and MethodsThe medical records of 82 patients who underwent loupe-assisted vasovasostomy with a Prolene stent by a single surgeon between January 2004 and December 2015 were reviewed. The association between the vasal obstructive interval (VOI) and the success rate was evaluated.ResultsThe average age at the time of vasovasostomy was 39.8 years (range, 29~57 years). The mean VOI was 6.6 years (range, 1~19 years). The mean operation time was 87.0 minutes (range, 55.0~140.0 minutes). The overall patency and natural pregnancy rates were 90.2% and 45.1%, respectively. The success rate decreased as time after vasectomy increased (odds ratio, 0.869; 95% confidence interval, 0.760~0.993; p=0.039). The cases were divided into 2 groups according to the mean VOI: group A (>7 years) and group B (≤7 years), with 31 cases (37.8%) and 51 cases (62.2%), respectively. The patency and pregnancy rates of group A were 80.6% and 51.6%, respectively, while those of group B were 96.1% and 41.2%, respectively.ConclusionsLoupe-assisted vasovasostomy using a Prolene stent is a safe and effective method.

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“…There have been several attempts with quantifying this risk in the literature. A recent meta-analysis has shown that obstructive interval greater than 10 years negatively impacts patency rates after vasectomy reversal (Herrel et al, 2015). The major weakness of this study is that it includes multiple surgeons and multiple techniques.…”

Section: Discussionmentioning

confidence: 99%

Pre‐operative risk factors associated with need for vasoepididymostomy at the time of vasectomy reversal

Fuchs

Anderson

Ostrowski³

et al. 2015

Andrology

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SUMMARYThe absence of sperm in the ejaculate after vasectomy reversal is commonly caused by failure to recognize and subsequently bypass epididymal or proximal vasal obstruction at the time of vasectomy reversal. If intra-operative proximal obstruction is suspected, vasoepididymostomy (VE) is recommended rather than vasovasostomy (VV). We sought to calculate the associated risk of needing VE, rather than VV with time from original vasectomy (obstructive interval) using a large cohort of vasectomy reversal patients. We reviewed the electronic and paper vasectomy reversal database by a single surgeon from 1978 through 2012. We performed univariate analysis to identify variables that predicted the need for VE rather than VV, and then combined only significant univariates into our multi-variable analysis. 2697 total men underwent vasectomy reversal, and 239 were repeat procedures. Of the 5296 individual testes operated on, 1029 were VE. Significant variables that predicted the need for VE on univariate analysis included: age, obstructive time interval, vasectomy reversal after previous VV (repeat vasectomy reversal), and year the procedure was performed. On multi-variable analysis significant risk factors for VE were age above 50 (OR 1.36), repeat vasectomy reversal (OR 5.78), and greater obstructive time interval (OR 1.56). For every 3 years since original vasectomy, the risk of needing VE increases by 56%. There is a linear relationship between obstructive interval and need for VE. Men undergoing repeat vasectomy reversal have five times greater risk of requiring VE and men greater than 50 years of age are also at higher risk. Using these pre-operative predictors is helpful in identifying patients who will benefit from referral to an experienced surgeon who can perform VE.

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Outcomes of Microsurgical Vasovasostomy for Vasectomy Reversal: A Meta-analysis and Systematic Review

Cited by 63 publications

References 15 publications

Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation

Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation

Loupe-Assisted Vasovasostomy Using a Prolene Stent: A Simpler Vasectomy Reversal Technique

Pre‐operative risk factors associated with need for vasoepididymostomy at the time of vasectomy reversal

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