Vasovasostomy: Current state of the art

Factors predicting overall success: a review of 747 microsurgical vasovasostomies

“…The popularity of the operation combined with increasing marital and relationship separation has resulted in a growing number of men requesting vasectomy reversal. 1,2 There are studies demonstrating acceptable patency and pregnancy rates of vasovasostomy (VV) without optical magnification 3,4 and improved success rates with optical loupe assisted VV. 5,6 Modern microsurgical techniques, as popularized by Silber,7 remain the standard with which all other methods of vasectomy reversal are compared.…”

“…Patency is over 80% in most microsurgical series, with patency approaching 100% in some reports. 3,[7][8][9][10][11][12][13] However, prediction of patency and preg- Patients were excluded if they did not provide a semen analysis (101 patients) or if they did not attempt to achieve a pregnancy (41 patients). The remaining 605 patients (81%) provided a minimum of 1 semen analysis; all of the samples were analyzed at the same andrology laboratory within our institution, which has previously reported on the use of AG in men with azoospermia.…”

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

“…Fertility rates following vasovasostomy using macro scopic techniques and with the aid of simple magnifica tion have averaged 35% with successes reaching up to 50% [2][3][4], However, patency rates as low as 30% with a final fertility of only 5-25% have also been reported [5,6], There is consensus now that with microscopic surgery the results can be considerably improved [7], Patency rates of 94% have been reported recently, with fertility rates of 64% when previous vasectomy had been performed with in a 1 0-year period [ 1 ] confirming the results of larger series from the USA and Australia [7][8][9]. A meticulous technique using microscope magnification and the thin nest nonirritant suture material such as 9/0 and preferably 10/0 nylon are mandatory to achieve accurate apposition of the divided ends, to attain unobstructed sperm flow and to prevent sperm leakage and granuloma formation.…”

Vasovasostomy Results in 66 Patients Related to Obstructive Intervals and Serum Agglutinin Titres

“…In the previously mentioned study of Broderick et al [13], only 2 out of 12 patients (with significant sperm-surface antibodies) had granulomas. In a review article by Cos et al [15] the presence of a sperm granulo ma at the site of ligation after vasectomy might be inter preted as a pressure relief valve. Those patients who underwent a reversal procedure, including removal of their granulomas before reanastomosis, had an explicit good quality sperm in their ejaculum.…”