Vasectomy reversal using a microsurgical three‐layer technique: one surgeon’s experience over 18 years with 1300 patients

Abstract

The technique and the results of microsurgical vasectomy reversal in a single-centre study over 18 years are presented. Both vasovasostomy (VV) and epididymovasostomy (EV) were carried out in a three-layer technique. With strict adherence to the strategy, end-to-end VV was only performed if spermatozoa had been demonstrated at the epididymal stump of the vas. In all other cases, EV was carried out in a preocclusive region of the epididymal tubule. The outpatient procedure of refertilization was associated with a very low complication rate, which underlines its minimal-invasive character. The follow-up rate was 71%, the overall patency rate was 89% and the pregnancy rate was 59%. Secondary azoospermia was only observed in 1% of the patients. In relation to the intervals of obstruction, the patency and pregnancy rates were higher after short-term obstruction than after long-term obstruction. Correspondingly, higher success rates were found after VV than after EV. This is understandable because the probability for indication of EV increases with longer periods of obstruction. There is a significant discrepancy between patency and pregnancy rates that is likely to be caused by a relevant number of patients with post-operative asthenozoospermia. The duration of obstruction is an important factor concerning epididymal damage, but it only disproportionately affects the results of refertilization if the technology of EV is implemented consistently in case of an epididymal granuloma. Good clinical results are achieved with this strategy, as evidenced by pregnancy rates and semen analyses.

The need for epididymovasostomy at vasectomy reversal plateaus in older vasectomies: a study of 1229 cases

“…We also sought to quantify ejaculated sperm output after reversal to better understand potential changes that occur in the reproductive tract with prolonged blockage. Viewed in the context of other, generally smaller, contemporary series of vasectomy reversal studies, our overall sperm patency rates compare very favourably across all vasectomy intervals (Lee, 1986; Matthews et al , 1995; Kolettis et al , 2002; Purohit & Turek, 2002; Schiff et al , 2005; Yang et al , 2007; Hsiao et al , 2012; Schwarzer, 2012; Schwarzer & Steinfatt, 2013). In addition, the case complexity in this series mirrors those in other large series of reversals, such that 30-40% of cases involve at least unilateral EV (Yang et al., 2007; Fuchs & Burt, 2002; Hsiao et al , 2012; Schwarzer & Steinfatt, 2013).…”

The Kinetics of Sperm Return and Late Failure Following Vasovasostomy or Vasoepididymostomy: A Systematic Review

“…13 Several groups have used azoospermia as the threshold for failure. 21,23 Finally, some studies used clinical pregnancy as a surrogate for patency in the absence of any SA data while others excluded patients entirely if postoperative SAs were not performed. 4,19 In short there is no agreed upon standardized definition of patency and failure and, thus, comparison between series is hedged with significant limitations.…”

“…Schwarzer, 23 and Schwarzer and Steinfatt 19 reported experience with VV and VE. A 3-layer VV technique was primarily used and in 1,195 VV cases there were a 92% patency rate and a 1% late failure rate.…”

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

“…Meanwhile, men present to infertility specialists for vasectomy reversal (VR) at an average age of 41 ( n = 1300), some of whom may also suffer from hypogonadism and report current or previous TRT use. 18 Therefore, clinicians need to be keenly aware of the effects of TRT and AAS on spermatogenesis and what treatment options are available to reverse these effects to restore spermatogenesis.…”