Vasoepididymostomy for Vasectomy Reversal: A Critical Assessment in the Era of Intracytoplasmic Sperm Injection

Kolettis, Peter N.; Thomas, Anthony J.

doi:10.1016/s0022-5347(01)64504-x

Cited by 170 publications

(85 citation statements)

References 20 publications

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“…13,21,29,30,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Most experts in this field agree that the technical experience of the surgeons is one of the most important factors for the success of VE. We reported our clinical experience of microsurgical LIVE in a series of 72 men with azoospermia due to epididymal obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…However, it should be noted that upfront assisted reproduction combined with surgical sperm retrieval is an expensive option. Cost analyses performed by various investigators have consistently demonstrated that for men who have obstructive azoospermia, surgical reconstruction remains a more cost-effective option compared to upfront assisted reproduction, [20][21][22][23][24][25][26] particularly if the couples have a low willingness to pay. 24 In the hands of experienced microsurgeons, patency rate of over 90% can be achieved with microsurgical VE.…”

Section: Alternative Management Optionsmentioning

confidence: 99%

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The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy (VE). Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE (LIVE) in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the preoperative evaluation along with the techniques of various VE will be described in this article.

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Section: Discussionmentioning

confidence: 99%

Section: Alternative Management Optionsmentioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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“…22 Sperm aspiration and advanced reproductive techniques should not be the first option if reconstruction is possible and costeffective. 23 Anabolic steroid use is on the rise and it is necessary to specifically ask the patient if he is using any type of illicit anabolic steroid compound or prescribed testosterone pharmaceutical (reviewed elegantly by de Souza and Hallak 24 ). It is not just the athletes and body builders that are of concern as testosterone supplementation as treatment for several nebulous indications (under the umbrella of 'hypogonadism') is being dispensed to men of all ages.…”

Section: The Medical and Surgical History: What Clues Might It Reveal?mentioning

confidence: 99%

Evaluation of the azoospermic male

2008

Fertility and Sterility

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When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to have in mind when embarking on the evaluation. Adjunctive laboratory tests, such as hormonal assays or genetic studies, are often complementary and/or additive and allow a very precise determination to be made as to the etiologies, either genetic or acquired. It is only with this information that a therapeutic plan can be made for the patient. As will be discussed, a targeted approach to testing is far more satisfying and cost-effective than a blind, shotgun approach. INTRODUCTIONIn most circumstances, azoospermia is diagnosed when no spermatozoa are detected upon microscopic evaluation of two centrifuged semen samples. As will be seen below, certain conditions only require a single semen specimen when coupled with history, physical examination or both. Azoospermia is found in approximately 1% of all men and up to 15% of infertile men, depending upon the demographic nature of the infertile cohort. 1 Aspermia is defined as a complete absence of seminal fluid during orgasm. Men with azoospermia should be evaluated in an effort to discover the underlying etiology of their condition, which will guide the formulation of a therapeutic plan. 2 A complete history and physical examination is mandatory, while measurement of reproductive hormones (testosterone, folliclestimulating hormone (FSH), luteinizing hormone (LH), prolactin and estradiol) are potentially helpful. Depending upon the certain or suspected diagnosis, a Y chromosomal microdeletion assay, a karyotype, cystic fibrosis mutation analysis, transrectal ultrasonography and renal ultrasonography may be helpful. There should be no single 'azoospermia panel' where all of these studies are ordered in a shotgun approach with no regard to the likely diagnosis. These adjunctive tests are ordered in a targeted way-only those that are necessary based upon the presumptive diagnosis are obtained. This presumptive diagnosis is arrived at by the evaluating clinician with a combination of the mind (what do the history, the semen analysis and the hormonal data suggest), the eyes (what does the patient's appearance suggest) and the fingers (what does the genital physical examination suggest). To be clear in one's thoughts, though, it requires a way of thinking about azoospermia, a process to focus on and an algorithm to follow.

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“…In addition, even the less successful VES procedure still results in a spontaneous pregnancy rate of 31-56%. Furthermore, the cost per delivery after microsurgery and after MESA/ICSI is much in favour of surgical treatment [13].…”

Section: Art or Surgery ?mentioning

confidence: 99%

Microsurgical vasectomy reversal: results and predictors of success

Dohle

Smit

2005

Androl.

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A B S T R A C TMicrosurgical vasectomy reversal is a challenge for the physician but successful treatment depends on the experience and skills of the surgeon. Fertility can often be restored, thus avoiding the need for artificial reproductive techniques. Also, the surgical procedures can be combined with sperm aspiration and cryopreservation, to be used for Intracytoplasmic sperm injection (ICSI) in cases of surgical failure. We describe the results of 217 vasovasostomy procedures, with special emphasis on recent technical refinements and prognostic indicators.

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Vasoepididymostomy for Vasectomy Reversal: A Critical Assessment in the Era of Intracytoplasmic Sperm Injection

Cited by 170 publications

References 20 publications

The evolution and refinement of vasoepididymostomy techniques

The evolution and refinement of vasoepididymostomy techniques

Evaluation of the azoospermic male

Microsurgical vasectomy reversal: results and predictors of success

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