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Wu FCW, Lo K. Initiating male contraception methods. Andrology 2024. [PMID: 39073522 DOI: 10.1111/andr.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/12/2024] [Accepted: 06/29/2024] [Indexed: 07/30/2024]
Abstract
Non-surgical (reversible) male contraception methods, when approved for general clinical application, should be made available to all interested men aged 18 50 years in good general health regardless of their semen parameters. In the preliminary workup, a complete personal and family history aimed at identifying specific conditions that may potentially increase the risks for adverse effects (associated with testosterone replacement) is advisable but a general or andrological examination is not required, unless indicated by the history. Baseline body weight, blood pressure and haemoglobin should be recorded for the purpose of future monitoring. While risks and benefits of vasectomy have been well established, appropriately nuanced patient counselling and assessment are essential for ensuring a satisfactory outcome of vasectomy.
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Affiliation(s)
- Frederick C W Wu
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
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2
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Touil W, Delaunay B, Prudhomme T, Roumiguie M, Game X, Soulie M, Isus F, Huyghe E. Sexual and couple outcomes of vasectomy: Results of a French questionnaire survey. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102672. [PMID: 38936777 DOI: 10.1016/j.fjurol.2024.102672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Vasectomy is a permanent contraceptive method that is increasingly appealing to French men with diverse patient profiles. An important question is the impact on sexual life. We aimed to specify the profile of men seeking vasectomy and its impact on their lives. METHOD Based on a consecutive series of 446 men undergoing vasectomy at a university center between April 2010 and March 2022, an online survey was launched in April 2022. In total, 177 patients responded to the questionnaire. The median time between surgery and questionnaire response was 33months (15, 50). At the time of vasectomy, the main age group was 36-45years (55%). RESULTS The reflection period before consultation exceeded 1year for 69%. At the time of surgery, only 8% of men were single and 18% were childless. Vasectomy was a couple's decision in 45% of cases. The main motivation was the shift in contraceptive burden for 76% of patients. Harmony in the couple was unchanged for 58% and improved for 33%. Libido remained stable for 79% and improved for 13%; 97% of men reported being satisfied with having undergone vasectomy; 96% had no regrets about surgery; 98% never considered having corrective surgery, and 99% never had a childbearing plan after the intervention. CONCLUSION Men increasingly share contraceptive burden. Vasectomy has no significant deleterious impact on sexual life. Satisfaction is high, and the vast majority of men undergoing vasectomy have no regret of their decision. Consequently, vasectomy should continue to expand in France. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Wafik Touil
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Boris Delaunay
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Service de Médecine de Reproduction, Hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex, France; UMR "Développement Embryonnaire Fertilité Environnement" (DEFE) 1203, INSERM, Université de Toulouse 3, Université de Montpellier, Montpellier, France
| | - Thomas Prudhomme
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mathieu Roumiguie
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Xavier Game
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Michel Soulie
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Isus
- Service de Médecine de Reproduction, Hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex, France; UMR "Développement Embryonnaire Fertilité Environnement" (DEFE) 1203, INSERM, Université de Toulouse 3, Université de Montpellier, Montpellier, France
| | - Eric Huyghe
- Département d'Urologie, de Transplantation Rénale et d'Andrologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Service de Médecine de Reproduction, Hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex, France; UMR "Développement Embryonnaire Fertilité Environnement" (DEFE) 1203, INSERM, Université de Toulouse 3, Université de Montpellier, Montpellier, France.
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3
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Maloney TJ, Swargaloganathan P, Hawksworth DJ. Cost Removed! Do Different Factors Influence Motivation for Vasectomy Reversal When Cost Is Not an Issue? Mil Med 2024:usae312. [PMID: 38870065 DOI: 10.1093/milmed/usae312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Vasectomy is a relatively common procedure performed for the purposes of sterilization; however, up to 6% of men that undergo vasectomy wish for its reversal at some point. Few studies have examined the motivation behind vasectomy reversal (VR), especially within special populations, such as the U.S. Military. The aim of this study was to examine the motivations of U.S. Military service members (SMs) who opted for VR surgery, considering their unique access to free health care. MATERIALS AND METHODS We conducted a retrospective record review of microsurgical VRs performed by a single surgeon (DJH) between January 2020 and May 2023. We evaluated patient's age at which vasectomy was performed, age at VR, reasons for seeking VR surgical care, number of children fathered before the vasectomy, and the age of the current partner. RESULTS A total of 106 patients underwent VR during the study period, and 102 of them had their medical records available for review. The average age at the time of vasectomy was 31.3 years, while the average age at VR was 40.2 years. The average spousal age at the time of seeking VR was 34.8 years. Before undergoing vasectomy, the men had fathered an average of 2.7 children. Most men were enlisted members of the military (68) and of all service branches, Army represented the greatest number (50). The vast majority of men (76) cited having a new partner after divorce as the primary motivation for seeking VR. Within this group, 57 were remarried, 15 were in a new relationship, 3 were newly engaged, and 1 desired fertility for future relationships. Additionally, 21 sought VR to have more children with the same spouse. Among them, motivating factors included changes to financial status and improvement in partner's health condition. A minority of patients (2) desired VR due to post vasectomy pain syndrome or religious beliefs. CONCLUSIONS Our study demonstrates that the primary driver for seeking VR surgical care among SMs was the desire for fertility with a new partner, which correlates with trends in the civilian sector. Approximately 20% of the men cited the wish to have more children with the same partner as their motivation. Non-fertility reasons, such as religious beliefs and post vasectomy pain syndrome, were also observed, albeit less frequently.
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Affiliation(s)
- Trevor J Maloney
- Division of Urology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | | | - Dorota J Hawksworth
- Division of Urology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Nguyen V, Li MK, Leach MC, Patel DP, Hsieh TC. Comparison of Childless and Partnerless Vasectomy Rates Before and After Dobbs v. Jackson Women's Health Organization. Am J Mens Health 2024; 18:15579883241260511. [PMID: 38872304 PMCID: PMC11179492 DOI: 10.1177/15579883241260511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
The Supreme Court ruling Dobbs v. Jackson Women's Health Organization (June 2022) overturned federal protection of abortion rights, resulting in significant impact on both male and female reproductive rights and health care delivery. We conducted a retrospective review of all patients who underwent vasectomy at a single academic institution between June 2021 and June 2023. Our objective was to compare the rates of childless and partnerless vasectomies 1 year before and after this ruling, as these men may be more susceptible to postprocedural regret. Of total, 631 men (median age = 39 years, range = 20-70) underwent vasectomy consultation. Total vasectomies pre- and post-Dobbs were 304 (48%) versus 327 (52%). Total childless and partnerless vasectomies pre- and post-Dobbs were 44 (42%) versus 61 (58%) and 43 (46%) versus 50 (54%). Vasectomy completion rate was slightly increased post-Dobbs (90% vs. 88%; p = .240). The post-Dobbs cohort had significantly less children (1.8 vs. 2.0; p = .031). Men in the post-Dobbs era were significantly more likely to be commercially insured (72% vs. 64%) and less likely to be uninsured (1% vs. 6%; p = .002). Men who underwent childless vasectomy were significantly more likely to be younger (36.4 vs. 39.8 years; p < .001). There was a significantly greater proportion of Hispanic and Black men in the partnerless cohort compared to the cohort with partners (24% vs. 19% and 9% vs. 2%; p = .002). In conclusion, patients should be counseled on the permanent nature of this procedure, underscoring need for effective and reversible male contraception.
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Affiliation(s)
- Vi Nguyen
- Department of Urology, UC San Diego Health, University of California, San Diego, La Jolla, CA, USA
| | - Michelle K Li
- Department of Urology, UC San Diego Health, University of California, San Diego, La Jolla, CA, USA
| | - Michelle C Leach
- Department of Urology, UC San Diego Health, University of California, San Diego, La Jolla, CA, USA
| | - Darshan P Patel
- Department of Urology, UC San Diego Health, University of California, San Diego, La Jolla, CA, USA
| | - Tung-Chin Hsieh
- Department of Urology, UC San Diego Health, University of California, San Diego, La Jolla, CA, USA
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Charles DK, Anderson DJ, Newton SA, Dietrich PN, Sandlow JI. Vasectomy Regret Among Childless Men. Urology 2023; 172:111-114. [PMID: 36481202 DOI: 10.1016/j.urology.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To address historical concerns surrounding vasectomy in childless men, we sought to evaluate for the level of regret in this unique cohort. METHODS The records of patients who underwent vasectomy via single surgeon between 2006 and 2021 were retrospectively reviewed and those who had not fathered children in any capacity at time of vasectomy were selected. We devised a 6-question survey inquiring about regret and thoughts on vasectomy reversal and assisted reproductive technology (ART). The questions are listed in Table 1. Patients were queried via a telephone call to rate their level of regret, both immediately after vasectomy and present day. The cohort was analyzed via age at time of vasectomy, time since vasectomy and marital status. RESULTS There were 4812 overall patients who underwent vasectomy in this interval, with 205 (4.3%) who were childless. The response rate was 33.2% (68/205). Average age was 36.6 years with average time since vasectomy at time of phone call was 5.51 years. Regret rate was 4.4% immediately following vasectomy and 7.4% at time of telephone interview. A confirmatory, second consultation before vasectomy was present in 6.8% (14/205). The majority of patients 150/205 (73.1%) were married. When patients were stratified by marital status, there was no significant difference in any of the questions. The majority of patients were satisfied with their decision, with few contemplating or pursuing reversal or ART (Table 1). CONCLUSION Regret in childless patients who undergo vasectomy is very rare, with the majority of patients feeling that their life was improved.
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Affiliation(s)
- David K Charles
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Sydney A Newton
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Peter N Dietrich
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
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6
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Dorjey Y. A successful Vasovasostomy operation. Clin Case Rep 2022; 10:e6794. [PMID: 36590668 PMCID: PMC9795087 DOI: 10.1002/ccr3.6794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/10/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
Vasectomy is performed as a permanent method of contraception for men after completing the family. Many men are seeking vasectomy reversal operations after remarrying new partners. The reversal operation is seen as a challenging procedure that requires a skilled surgeon and sophisticated instruments. This write-up reports a case of vasovasostomy performed successfully on an elderly man using the minimal available facilities at Phuentsholing General Hospital, Bhutan.
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Affiliation(s)
- Yeshey Dorjey
- Consultant Obstetricians and Gynaecologist, Phuentsholing General HospitalPhuentsholingBhutan
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7
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Anderson DJ, Lucero M, Vining S, Daniel C, Hasoon J, Viswanath O, Kaye AD, Urits I. Vasectomy Regret or Lack Thereof. Health Psychol Res 2022; 10:38241. [PMID: 36118980 PMCID: PMC9476225 DOI: 10.52965/001c.38241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Vasectomy is a procedure that results in permanent yet reversible sterility and remains a great contraceptive option for many. Previous research studies have highlighted frequency of vasectomy utilization, defining characteristics of individuals who opt for this method, various surgical techniques, and the risks and benefits associated with the procedure. What remains to be defined is why or why not individuals may experience post-vasectomy regret and whether the previous characteristics correlate. Objective The objective of this review is to synthesize information regarding reasons individuals may regret their vasectomy and seek reversal, what options exist for accomplishing the reversal, and patients' fertility prognosis post-vasovasostomy. Methods This review utilized a combination of secondary and tertiary data analysis across a wide scope of academic databases pertaining to the topic of interest. Results Typically, most males who have sought a vasectomy are satisfied with their decision, however, approximately 6% of this population seeks reversal. Key factors influencing vasectomy regret include age at the time of vasectomy, parental status, pre- and post-operative relationship status, unresolved physical and psychosexual problems, and development of chronic scrotal pain following the procedure. Few options exist for vasectomy reversal including microsurgical reconstructive vasectomy reversal (VR) and sperm extraction for in vitro fertilization. There is no guarantee that fertility will be restored in any case but a major predictive factor for success is the time interval prior to reversal. Conclusion Vasectomy is intended to be a permanent form of contraception; however, a minor chance remains that individuals may experience post-operative regret due to various factors. This warrants proper comprehensive counseling by the patient's provider regarding benefits and risks, procedural outcomes, opportunities for reversal, and fertility prognosis.
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Affiliation(s)
| | | | | | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
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Samplaski MK, Rodman JCS, Perry JM, Marks MBF, Zollman R, Asanad K, Marks SF. Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal. Andrologia 2022; 54:e14439. [PMID: 35524153 PMCID: PMC9541413 DOI: 10.1111/and.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post‐VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
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Affiliation(s)
- Mary K Samplaski
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - John C S Rodman
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA
| | | | | | - Robert Zollman
- International Center for Vasectomy Reversal, Tucson, Arizona, USA
| | - Kian Asanad
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Sheldon F Marks
- International Center for Vasectomy Reversal, Tucson, Arizona, USA
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Zini A, Grantmyre J, Chow V, Chan P. UPDATE - 2022 Canadian Urological Association best practice report: Vasectomy. Can Urol Assoc J 2022; 16:E231-E236. [PMID: 35544354 PMCID: PMC9119596 DOI: 10.5489/cuaj.7860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - John Grantmyre
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Victor Chow
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter Chan
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
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Degraeve A, Roumeguere T, Tilmans G, Marotta ML, Huyghe E, Fournier G, Faix A, Spinoit AF, Decaestecker K, Herve F, Boitrelle F, Lahdensuo K, Van Damme J. European Countries have different rates of sperm cryopreservation before vasectomy and at the time of reversal. Andrology 2022; 10:1286-1291. [PMID: 35396922 DOI: 10.1111/andr.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/15/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Effective male contraceptive options are condoms and vasectomy. Vasectomy should not be considered as a reversible method of contraception even if vasovasostomy can be offered to men to restore fertility after vasectomy. Therefore, there is a real questioning among urologist concerning cryopreservation before vasectomy. We carried out an international survey concerning the practice of cryopreservation before vasectomy and during vasovasostomy. MATERIAL AND METHODS An online anonymous survey was submitted from January to June 2021 to 6 European urological societies. The 31-items questionnaire included questions about demography, habits of cryopreservation before vasectomy or during vasectomy reversal and in case of urogenital cancers. RESULTS 228 urologists from six urological societies in five different countries (Belgium, Netherlands, Luxembourg, France, Finland) answered the questionnaire. French urologists were more in favor of cryopreservation before vasectomy than other European urologists (p<0,0001). They also significantly found that not talking about cryopreservation before vasectomy is a medical fault unlike other urologists (p<0,0001). The specialization in andrology did not influence the choice of cryopreservation before vasectomy (p = 0,9452). The majority of urologists did not perform intraoperative sperm extraction during vasovasostomy (81%; n = 127) with a significant difference between urologists with or without andrology training (p = 0,0146). Success rates after vasovasostomy are significantly better for robot-assisted surgery (p = 0.0159) or with microscope (p = 0.0456) versus without microscope. CONCLUSION Cryopreservation before definitive sterilization significantly varies among European urologists and seems to be mostly dictated by habits than by knowledge. An international consensus is needed to standardize practices and guide patient's choice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Amandine Degraeve
- Department of Urology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | - Thierry Roumeguere
- Department of Urology, University Clinics Brussels, Erasme hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Tilmans
- Unit of Abdominal Surgery, Saint-Luc University Clinics, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Laura Marotta
- Department of Andrology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | - Eric Huyghe
- Department of Urology - Kidney transplantation - Andrology - Rangueil Hopital, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Reproductive Medicine, Paule de Viguier Hospital, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,UMR 1203 « DEFE » (Development - Embryo - Fertility - Environment) - INSERM - Université de Toulouse - Université de Montpellier, France
| | | | - Antoine Faix
- Department of Urology, Clinique Beau Soleil, Montpellier, France
| | | | | | - François Herve
- Department of Urology, Ghent University Hopsital, Ghent, Belgium.,Department of Urology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Kanerva Lahdensuo
- Department of Urology and Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Julien Van Damme
- Department of Urology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
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11
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Rew KT. Surgery of the Male Genital Tract. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Basourakos SP, Lewicki P, Punjani N, Arenas-Gallo C, Gaffney C, Fantus RJ, Al Awamlh BAH, Schlegel PN, Brannigan RE, Shoag JE, Halpern JA. Practice patterns of vasal reconstruction in a large United States cohort. Andrologia 2021; 53:e14228. [PMID: 34459018 DOI: 10.1111/and.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
We aimed to characterise diverse practice patterns for vasal reconstruction and to determine whether surgeon volume is associated with vasoepididymostomy performance at the time of reconstruction. We identified adult men who underwent vasal reconstruction from 2000 to 2020 in Premier Healthcare Database and determined patient, surgeon, cost and hospital characteristics for each procedure. We identified 3,494 men who underwent either vasovasostomy-alone (N = 2,595, 74.3%) or any-vasoepididymostomy (N = 899, 25.7%). The majority of providers (N = 487, 88.1%) performed only-vasovasostomy, 10 (1.8%) providers performed only-vasoepididymostomy and 56 (10.1%) providers performed both. Median total hospital charge of vasoepididymostomy was significantly higher than vasovasostomy ($39,163, interquartile range [IQR]$11,854-53,614 and $17,201, IQR$10,904-29,986, respectively). On multivariable regression, men who underwent procedures at nonacademic centres (OR 2.71, 95% CI 2.12-3.49) with higher volume surgeons (OR 11.60, 95% CI 8.65-16.00) were more likely to undergo vasoepididymostomy. Furthermore, men who underwent vasoepididymostomy were more likely to self-pay (OR 2.35, 95% CI 1.83-3.04, p < .001) and more likely had procedures in the Midwest or West region (OR 2.22, 95% CI 1.66-2.96 and OR 2.11, 95% CI 1.61-2.76, respectively; p < .001). High-volume providers have increased odds of performing vasoepididymostomy at the time of reconstruction but at a significantly higher cost. These data suggest possibly centralising reconstructive procedures among high-volume providers.
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Affiliation(s)
- Spyridon P Basourakos
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Patrick Lewicki
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Nahid Punjani
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher Gaffney
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Peter N Schlegel
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan E Shoag
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Fantus RJ, Halpern JA. Vasovasostomy and vasoepididymostomy: indications, operative technique, and outcomes. Fertil Steril 2021; 115:1384-1392. [PMID: 33926720 DOI: 10.1016/j.fertnstert.2021.03.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022]
Abstract
The basic principles of vasal reconstruction have endured since their initial description over a century ago, yet the nuances and technical approaches have evolved. Prior to performing vasectomy reversal, the clinician should perform a focused history, physical and laboratory assessment, all of which are critical for patient counseling and preoperative planning. Operative success is contingent on appropriate intraoperative decision making and technical precision in completing a tension-free, watertight, and patent anastomosis. Outcomes of vasectomy reversal differ on the basis of the type of reconstruction required, reconstructive technique, and patient-specific factors. Here we review the indications, surgical techniques, and outcomes of vasectomy reversal.
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Affiliation(s)
- Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Ravindraanandan M, Ong CT, Elhadi M, Mahmalji W, Akhtar M. Vasectomy reversal: a review on outcomes using a loupe-assisted vasovasostomy approach. Aging Male 2020; 23:1217-1219. [PMID: 32138580 DOI: 10.1080/13685538.2020.1737854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Vasectomy is a popular choice of contraception worldwide. In the UK, vasectomy reversal is not usually licensed under the NHS with reports on outcomes being limited. Microsurgical reversal is a technique commonly performed under the operating microscope. Loupe magnification, however, is emerging as a safe and reliable technique to perform microsurgery. METHOD Loupe-assisted microsurgical vasovasotomies were performed on 14 men in a 3-year period. Indications for the procedure were for fertility only. Semen analysis variables were measured against European Association of Urologists (EAU) guidelines at six weeks. Patients were followed-up at clinic in three months. Data were collated using operation notes and cytology results, and analysed using descriptive statistics. Pearson's correlation coefficient was used to compare years after vasectomy, and age to sperm count. RESULTS The average sperm count in our group was 41.3 million per millilitre (median 29.95, range 2.7-107.8) at 6 weeks. Seventy-five per cent were found to have positive sperm motility, and all had acceptable sperm morphology at follow-up. A very low to weak correlation between time after vasectomy and age, with sperm count. CONCLUSION We have demonstrated that fertility and post-operative outcomes using a loupe-assisted microsurgical vasovasotomy approach are favourable as per EAU guidelines.
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Affiliation(s)
- Manoj Ravindraanandan
- County Hospital Hereford, Hereford, United Kingdom of Great Britain and Northern Ireland
| | - Chea Tze Ong
- County Hospital Hereford, Hereford, United Kingdom of Great Britain and Northern Ireland
| | - Mohammed Elhadi
- County Hospital Hereford, Hereford, United Kingdom of Great Britain and Northern Ireland
| | - Wasim Mahmalji
- County Hospital Hereford, Hereford, United Kingdom of Great Britain and Northern Ireland
| | - Mehmood Akhtar
- County Hospital Hereford, Hereford, United Kingdom of Great Britain and Northern Ireland
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Surgery of the Male Genital Tract. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bryk DJ, Murthy PB, DeWitt-Foy M, Sun AY, Parekh NV, Sabanegh E, Vij SC. Childless Men at the Time of Vasectomy are Unlikely to Seek Fertility Restoration. Urology 2019; 136:142-145. [PMID: 31843622 DOI: 10.1016/j.urology.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine whether men who were childless at the time of vasectomy sought consultation for fertility restoration. METHODS Retrospective chart review was performed to determine if patients without children at the time of vasectomy sought consultation for fertility restoration (defined as vasectomy reversal or sperm retrieval). If the patient had not been seen in our healthcare system within the previous 12 months, he was contacted by phone to determine whether he had sought consultation for fertility restoration. RESULTS Of 1656 men, 68 men (4.1%) were childless at the time of vasectomy. Fifteen patients were excluded as they were not followed in our hospital system and were unreachable by phone. Zero patients sought consultation for fertility restoration. CONCLUSION Our single institution study demonstrated that no men who were childless at the time of vasectomy sought consultation for fertility restoration. Given that there are no other FDA approved methods for nonbarrier sterilization for males, men with no children at the time of vasectomy should receive the same AUA guideline-recommended counseling that men with children receive.
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Affiliation(s)
- Darren J Bryk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Prithvi B Murthy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Molly DeWitt-Foy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Andrew Y Sun
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Neel V Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Edmund Sabanegh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
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Pinto LOAD, de Barros CAV, de Lima AB, Dos Santos DR, de Bacelar HPH. Portable model for vasectomy reversal training. Int Braz J Urol 2019; 45:1013-1019. [PMID: 31268638 PMCID: PMC6844345 DOI: 10.1590/s1677-5538.ibju.2019.0092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/23/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to validate an experimental non-animal model for training of vasectomy reversal. MATERIALS AND METHODS The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. RESULTS Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). CONCLUSION The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.
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Affiliation(s)
- Luis Otávio Amaral Duarte Pinto
- Programa de Mestrado Profissional em Cirurgia e Pesquisa Experimental, Universidade do Estado do Pará - Uepa, Belém, PA, Brasil
| | | | - Anderson Bentes de Lima
- Programa de Mestrado Profissional em Cirurgia e Pesquisa Experimental, Universidade do Estado do Pará - Uepa, Belém, PA, Brasil
| | - Deivid Ramos Dos Santos
- Programa de Mestrado Profissional em Cirurgia e Pesquisa Experimental, Universidade do Estado do Pará - Uepa, Belém, PA, Brasil
| | - Herick Pampolha Huet de Bacelar
- Programa de Mestrado Profissional em Cirurgia e Pesquisa Experimental, Universidade do Estado do Pará - Uepa, Belém, PA, Brasil
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Patient Factors Influencing Decision to Undergo Vasectomy Reversal. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Khan AI, Patil D, Kawwass JF, Zholudev V, Mehta A. Surgical sterilization among US men and women with employer-based insurance: A claims data analysis. Contraception 2018; 98:247-251. [PMID: 29778585 DOI: 10.1016/j.contraception.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To assess variability in the use of surgical sterilization among privately insured U.S. men and women. STUDY DESIGN We queried the MarketScan Commercial Claims database using CPT, ICD9, and HCPCS codes to identify 658,509 individuals between 18-65 years old (0.37% of total) who underwent male or female sterilization between 2009-2014. We examined annual trends using Cochran-Mantel-Haenszel test. We analyzed differences in age, geographic distribution, and family size using Wilcoxon sum-rank and generalized chi-squared tests. RESULTS Between 2009-2014, 422,290 men (0.55% of total men) and 236,219 women (0.24% of total women) with employer-sponsored insurance underwent male and female sterilization, respectively. Annual male sterilizations decreased from 77,565 (0.60%) in 2009 to 61,436 (0.51%) in 2014 (p<.001), while annual female sterilizations decreased from 43,766 (0.26%) to 30,465 (0.19%) (p<.001) over the same time period. Median age at time of male or female sterilization was 38 and 37 years, respectively. The decision to undergo sterilization at age 35 or older was associated with family size of 4 or more individuals (p<.001). Sterilization was more common in urban areas, with 84% of male sterilizations and 79% of female sterilizations performed in urban areas. 79% of men compared to 60% of women who underwent sterilization were the primary policyholders of their employer-sponsored healthcare plans (p<.001). CONCLUSION Male sterilization was twice as common as female sterilization in this privately insured cohort. Use of surgical sterilization was associated with increased age and larger family size. There was a decline in the annual number of male and female sterilizations during the study period. IMPLICATIONS Male sterilization is more common among US men with employer-based insurance than among the general population. The decline in sterilization may reflect cultural factors and the rise of long-acting reversible contraception. Analyzing the sociodemographic factors impacting sterilization may provide insight into contraceptive choice and improve reproductive health services.
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Affiliation(s)
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Jennifer Fay Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Vitaly Zholudev
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
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Vasectomy Reversal Surgical Patterns: An Analysis of the American Board of Urology Case Logs. Urology 2017; 107:107-113. [DOI: 10.1016/j.urology.2016.08.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/06/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022]
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Marshall MT, Doudt AD, Berger JH, Auge BK, Christman MS, Choe CH. Robot-assisted vasovasostomy using a single layer anastomosis. J Robot Surg 2016; 11:299-303. [DOI: 10.1007/s11701-016-0653-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/25/2016] [Indexed: 11/25/2022]
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Canadian Contraception Consensus Chapter 6 Permanent Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015. [DOI: 10.1016/s1701-2163(16)39377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dickey RM, Pastuszak AW, Hakky TS, Chandrashekar A, Ramasamy R, Lipshultz LI. The Evolution of Vasectomy Reversal. Curr Urol Rep 2015; 16:40. [DOI: 10.1007/s11934-015-0511-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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MRI of the Epididymis: Can the Outcome of Vasectomy Reversal Be Predicted Preoperatively? AJR Am J Roentgenol 2014; 203:91-8. [DOI: 10.2214/ajr.13.11619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Niederberger C. Re: Vasectomy Demographics and Postvasectomy Desire for Future Children: Results from a Contemporary National Survey. J Urol 2014. [DOI: 10.1016/j.juro.2013.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Safarinejad MR, Lashkari MH, Asgari SA, Farshi A, Babaei AR. Comparison of macroscopic one-layer over number 1 nylon suture vasovasostomy with the standard two-layer microsurgical procedure. HUM FERTIL 2013; 16:194-9. [DOI: 10.3109/14647273.2013.805256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sharma V, Le BV, Sheth KR, Zargaroff S, Dupree JM, Cashy J, Brannigan RE. Vasectomy demographics and postvasectomy desire for future children: results from a contemporary national survey. Fertil Steril 2013; 99:1880-5. [PMID: 23541407 DOI: 10.1016/j.fertnstert.2013.02.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the longitudinal demographics and family planning attitudes of vasectomized men with the use of the National Survey for Family Growth (NSFG). DESIGN Retrospective cohort analysis of the NSFG with the use of national projections and multivariable regressions. SETTING In-home survey. PATIENT(S) The NSFG sampled 10,403 men aged 15-45 years from 2006 to 2010 regarding family planning attitudes. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Vasectomy and desire for children. RESULT(S) There were 3,646,339 (6.6%) vasectomized men aged 18-45 years in the U.S. On multivariable regression the following factors increased the odds of having a vasectomy: currently married (odds ratio [OR] 7.814), previously married (OR 5.865), and increased age (OR 1.122) and income (OR 1.003). The odds of having a vasectomy increased with number of children. The following factors decreased the odds of having a vasectomy: immigrant status (OR 0.186), African American (OR 0.226), Hispanic (OR 0.543), Catholic (OR 0.549), and other non-Protestant religion (OR 0.109). Surprisingly, an estimated 714,682 (19.6%) vasectomized men in the U.S. desire future children. Men practicing a religion (OR 8.575-15.843) were more likely than atheists to desire children after vasectomy. 71,886 (2.0%) vasectomized men reported having a vasectomy reversal. CONCLUSION(S) This study highlights the importance of preoperative counseling for permanency of vasectomy and reveals an opportunity to counsel couples about vasectomy versus tubal ligation.
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Affiliation(s)
- Vidit Sharma
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Miyaoka R, Esteves SC. Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role? Clinics (Sao Paulo) 2013; 68 Suppl 1:111-9. [PMID: 23503960 PMCID: PMC3583159 DOI: 10.6061/clinics/2013(sup01)12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 04/11/2012] [Indexed: 01/06/2023] Open
Abstract
Obstructive azoospermia is a relatively common male infertility condition. The main etiologies of obstructive azoospermia include congenital, surgical-derived, traumatic and post-infectious cases. Although seminal tract reconstruction is a cost-effective treatment in most cases, this approach may not be feasible or desired in some cases. In such cases, assisted reproduction techniques offer a method for achieving pregnancy, notably via sperm retrieval and intracytoplasmic sperm injection. This process requires several considerations and decisions to be made, including the cause and duration of obstruction, which sperm retrieval technique to use, and whether to use fresh or frozen-thawed sperm. We present a review of obstructive azoospermia and assisted reproduction techniques, highlighting the most relevant aspects of the decision-making process for use in clinical practice.
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Affiliation(s)
- Ricardo Miyaoka
- Referral Center for Male Reproduction, ANDROFERT - Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil
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Lee HS, Seo JT. Advances in surgical treatment of male infertility. World J Mens Health 2012; 30:108-13. [PMID: 23596597 PMCID: PMC3623518 DOI: 10.5534/wjmh.2012.30.2.108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/06/2012] [Accepted: 08/09/2012] [Indexed: 11/15/2022] Open
Abstract
A male factor is the only cause of infertility in 30% to 40% of couples. Most causes of male infertility are treatable, and the goal of many treatments is to restore the ability to conceive naturally. Varicoceles are present in 15% of the normal male population and in approximately 40% of men with infertility. Varicocele is the most common cause of male infertility that can be corrected surgically. In males with azoospermia, the most common cause is post-vasectomy status. Approximately 6% of males who undergo vasectomy eventually seek reversal surgery. Success of vasectomy reversal decreases with the number of years between vasectomy and vasovasostomy. Other causes of obstructive azoospermia include epididymal, vasal or ejaculatory duct abnormalities. Epididymal obstruction is the most common cause of obstructive azoospermia. Patients with epididymal obstruction without other anatomical abnormalities can be considered as candidates for vasoepididymostomy. With microsurgical techniques, success of patency restoration can reach 70~90%. In case of surgically uncorrectable obstructive azoospermia, sperm extraction or aspiration for in vitro fertilization is needed. Nonobstructive azoospermia is the most challenging type of male infertility. However, microsurgical testicular sperm extraction may be an effective method for nonobstructive azoospermia patients.
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Affiliation(s)
- Hyo Serk Lee
- Department of Urology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
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Gillois P, Rigot JM, Juillard JC, Hennebicq S. Cryoconservation de spermatozoïdes avant vasectomie: utilité et paradoxes à travers l’activité des CECOS. Basic Clin Androl 2012. [DOI: 10.1007/s12610-012-0196-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Résumé
Le recours à la vasectomie demeure largement moins utilisé en France que dans d’autres pays comme le montrent les données présentées dans cet article. Par ailleurs, environ 12 % des hommes qui ont recours à ce moyen de stérilisation volontaire vont dans le même temps procéder à une congélation de spermatozoïdes. Proposer de préserver la fertilité d’hommes qui n’envisagent pas ou plus de projet de paternité peut apparaître paradoxal. Nous reprenons dans cet article les éléments de réglementation, réflexion et évolution au cours du temps de la pratique de la vasectomie combinée à la congélation de spermatozoïdes. Les données montrent qu’environ 5 % des hommes qui ont préservé leur fertilité avant la chirurgie demanderont ultérieurement une utilisation de ces spermatozoïdes, le plus souvent lors d’une nouvelle union. L’analyse de l’évolution des pratiques montre également qu’actuellement, le recours aux inséminations artificielles a été largement supplanté par l’utilisation des techniques de fécondation in vitro avec des chances de grossesse nettement supérieures. Enfin, au regard de l’évolution de la réglementation et de l’évolution des pratiques, nous posons la question de l’utilité de continuer à proposer une préservation de fertilité préalablement à la vasectomie et présentons des pistes de réflexion sur ce point.
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Fenig DM, Kattan MW, Mills JN, Gisbert M, Yu C, Lipshultz LI. Nomogram to preoperatively predict the probability of requiring epididymovasostomy during vasectomy reversal. J Urol 2011; 187:215-8. [PMID: 22099990 DOI: 10.1016/j.juro.2011.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE Up to 6% of men who undergo vasectomy may later undergo vasectomy reversal. Most men require vasovasostomy but a smaller subset requires epididymovasostomy. Outcomes of epididymovasostomy depend highly on specialized training in microsurgery and, if predicted preoperatively, might warrant referral to a specialist in this field. We created a nomogram based on preoperative patient characteristics to better predict the need for epididymovasostomy. MATERIALS AND METHODS We evaluated patients who underwent primary vasectomy reversal during a 5-year period. Preoperative and intraoperative patient data were collected in a prospectively maintained database. We evaluated the ability of age, years since vasectomy, vasectomy site, epididymal fullness and granuloma presence or absence to preoperatively predict the need for epididymovasostomy in a given patient. The step-down method was used to create a parsimonious model, on which a nomogram was created and assessed for predictive accuracy. RESULTS Included in the study were 271 patients with a mean age of 42 years. Patient age was not positively associated with epididymovasostomy. Mean time from vasectomy to reversal was 9.7 years. Time to reversal and a sperm granuloma were selected as important predictors of epididymovasostomy in the final parsimonious model. The nomogram achieved a bias corrected concordance index of 0.74 and it was well calibrated. CONCLUSIONS Epididymovasostomy can be preoperatively predicted based on years since vasectomy and a granuloma on physical examination. Urologists can use this nomogram to better inform patients of the potential need for epididymovasostomy and whether specialist referral is needed.
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Affiliation(s)
- David M Fenig
- Cheseapeake Urology Associates, Baltimore, Maryland 20759, USA
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Marchi NM, Alvarenga ATD, Osis MJD, Godoy HMDA, Guimarães MCB, Bahamondes L. Consequências da vasectomia: experiência de homens que se submeteram à cirurgia em Campinas (São Paulo), Brasil. SAUDE E SOCIEDADE 2011. [DOI: 10.1590/s0104-12902011000300004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever a experiência de homens vasectomizados há pelo menos um ano em serviços públicos de saúde de Campinas, Estado de São Paulo. Procedimentos metodológicos: estudo descritivo com um componente qualitativo e outro quantitativo. Para a etapa qualitativa, realizaram-se 10 entrevistas semiestruturadas com homens selecionados de acordo com critérios propositais de escolaridade e número de filhos. Em seguida, foi aplicado um formulário estruturado a 202 homens, sorteados a partir da lista completa daqueles que haviam sido vasectomizados entre 1998 e 2004. Realizou-se análise temática do conteúdo das entrevistas semiestruturadas. Os dados quantitativos foram digitados e foi realizada análise descritiva. RESULTADOS: Observou-se que 97% dos homens estavam satisfeitos por terem feito a cirurgia e poucos referiram efeitos indesejados. Entre os poucos homens insatisfeitos, apenas um havia feito a reversão da cirurgia porque vivia com uma nova companheira e queria ter filhos; entre os demais a insatisfação devia-se à dor provocada pelo procedimento cirúrgico. A maioria dos entrevistados atribuiu à vasectomia mudanças para melhor sobre sua saúde, corpo, relacionamento em geral com a família e com a esposa, na vida sexual e na situação econômica. Prevaleceu a ideia de que a vasectomia só trouxera benefícios. A possibilidade de arrependimento foi mencionada pelos entrevistados como algo que não aconteceria com eles. CONCLUSÃO: Os resultados deste estudo permitiram verificar que os homens que optam pela vasectomia tendem a ver o método como fator de mudanças positivas, principalmente sobre a vida sexual e o relacionamento com a companheira e a família em geral.
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Shih G, Turok DK, Parker WJ. Vasectomy: the other (better) form of sterilization. Contraception 2010; 83:310-5. [PMID: 21397087 DOI: 10.1016/j.contraception.2010.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 11/30/2022]
Abstract
Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.
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Affiliation(s)
- Grace Shih
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
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Michielsen D, Beerthuizen R. State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation. EUR J CONTRACEP REPR 2010; 15:136-49. [DOI: 10.3109/13625181003682714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nagler HM, Jung H. Factors Predicting Successful Microsurgical Vasectomy Reversal. Urol Clin North Am 2009; 36:383-90. [DOI: 10.1016/j.ucl.2009.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kolettis PN. Restructuring reconstructive techniques--advances in reconstructive techniques. Urol Clin North Am 2008; 35:229-34, viii-ix. [PMID: 18423243 DOI: 10.1016/j.ucl.2008.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Microsurgical reconstruction to correct male infertility, although usually performed for vasectomy reversal, also is performed to correct other types of iatrogenic, congenital, and postinflammatory obstruction. In an effort to improve success rates and facilitate performance of these complex microsurgical procedures, modifications are continually suggested. This article reviews some of these proposed modifications. The modifications can be divided into five general categories: (1) use of biomaterials/sealants, (2) laser soldering, (3) use of absorbable and nonabsorbable stents, (4) new intussusception vasoepididymostomy (VE) anastomotic techniques, and (5) use of robotics.
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Affiliation(s)
- Peter N Kolettis
- Division of Urology, Department of Surgery, University of Alabama at Birmingham, 1530 Third Avenue South, FOT 1105, Birmingham, AL 35294-3411, USA.
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Abstract
Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90-95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade.
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Affiliation(s)
- Stephanie T Page
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Busato Junior WF, Marquetti AM, Rocha LC. Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats. Int Braz J Urol 2007; 33:829-36. [DOI: 10.1590/s1677-55382007000600012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2006] [Indexed: 11/22/2022] Open
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Klein WMP, Cerully JL. Health-Related Risk Perception and Decision-Making: Lessons from the Study of Motives in Social Psychology. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2007. [DOI: 10.1111/j.1751-9004.2007.00023.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Patel SR, Sigman M. Comparison of outcomes of vasovasostomy performed in the convoluted and straight vas deferens. J Urol 2007; 179:256-9. [PMID: 18001786 DOI: 10.1016/j.juro.2007.08.169] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Indexed: 12/19/2022]
Abstract
PURPOSE We compared postoperative semen analysis parameters and patency rates of vasovasostomy performed in the convoluted vs straight portion of the vas deferens. MATERIALS AND METHODS Records of patients that underwent bilateral vasovasostomy in the straight and convoluted vas deferens by a single surgeon were retrospectively analyzed. Patient age, partner age, obstructive interval, gross and microscopic appearance of the intraoperative fluid aspirated from the testicular portion of the vas deferens, and postoperative semen analysis results were examined. Patency was defined as any sperm in the postoperative ejaculate and was compared for the 2 groups. RESULTS A total of 42 and 64 patients underwent bilateral straight vasovasostomy and convoluted vasovasostomy, respectively. Mean patient age for straight and convoluted vasovasostomy was 38.5 and 40.3 years, respectively. Mean obstructive interval for straight vasovasostomy and convoluted vasovasostomy was 7.7 and 8.6 years, respectively. No significant differences in the postoperative semen analysis parameters of volume, total count, sperm density, motility or total motile count were found between the 2 groups. The patency rate was 98.1% and 97.3% for convoluted vasovasostomy and straight vasovasostomy, respectively, and was not statistically different. CONCLUSIONS Although vasovasostomy in the convoluted vas deferens is considered technically more challenging than in the straight vas deferens, patency rates and postoperative semen analysis parameters for convoluted vasovasostomy and straight vasovasostomy are comparable.
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Affiliation(s)
- Sutchin R Patel
- Division of Urology, Brown Medical School, Providence, Rhode Island 02905, USA
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Pasqualotto FF, Pasqualotto EB, Sobreiro BP, Hallak J, Medeiros F, Lucon AM. Clinical diagnosis in men undergoing infertility investigation in a university hospital. Urol Int 2006; 76:122-5. [PMID: 16493211 DOI: 10.1159/000090873] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 11/09/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It was the aim of this study to assess whether the changes in the diagnostic techniques and treatment modalities have altered the epidemiology of male factor infertility in the last decade. MATERIAL AND METHODS From September 1999 to July 2003, 822 patients were evaluated for infertility in a University Hospital. We divided our infertility patients according to the clinical diagnosis. RESULTS Most of the patients presented with varicocele (n = 282, 34.3%), idiopathic infertility (n = 260, 31.6%), or had had seminal tract obstruction (n = 85, 10.34%). Least common but equally important causes found were mumps (n = 43, 5.23%), pyospermia (n = 37, 4.5%), systemic diseases (n = 36, 4.37%), testicular failure (n = 34, 4.13%), cryptorchidism (n = 14, 1.7%), ejaculatory dysfunction (n = 11, 1.3%), genetics (n = 9, 1.1%), endocrinopathies (n = 4, 0.5%), testicular cancer (n = 4, 0.5%), and testicular torsion (n = 3, 0.36%). CONCLUSIONS Even with the changes in reproductive healthcare in the last years, varicocele and seminal tract obstruction remain the leading causes of male infertility. However, clinicians should not forget other treatable causes of male infertility such as pyospermia, systemic diseases, or testicular cancer.
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Abstract
Abstract
Intracytoplasmic sperm injection (ICSI) allows the treatment of virtually every type of male infertility. Unlike in vitro fertilization (IVF), its success does not depend on sperm concentration, motility or morphology and most of the physical barriers to fertilisation are by-passes. Since ICSI does not require strongly motile sperm, its use has now been expanded to incorporate immature sperm from the testes and epididymides. Successful fertilisation, pregnancies and healthy babies have all been reported. However, concerns about the safety of ICSI remain due to its short clinical history and the lack of testing on animal models.
Male fertility potential for assisted reproduction by ICSI cannot be measured by conventional parameters. Sperm DNA integrity is increasingly recognised as a more useful indicator. Studies have shown that sperm with higher levels of DNA damage have lower fertilisation rates after IVF and ICSI. Sperm with DNA damage above a certain threshold are associated with a longer time to conceive in otherwise apparently fertile couples and a higher miscarriage rate. DNA damage has been shown to be associated with impaired embryo cleavage. Our group has shown that sperm DNA from testicular sperm is less fragmented than that from epididymal sperm and suggest its preferred use in ICSI.
In addition to nuclear (n) DNA we also assessed the quality of mitochondrial (mt) DNA from testicular sperm from men with obstructive azoospermia undergoing ICSI. We observed that couples achieving a pregnancy had both less mtDNA deletions and less nDNA fragmentation. We found inverse relationships between pregnancy and sperm mtDNA deletion numbers, size and nDNA fragmentation. No relationships were observed with fertilisation rates. With this knowledge, we designed an algorithm for the prediction of pregnancy based on the quality of sperm nDNA and mtDNA.
Each year 40,000 men have a vasectomy in the UK but every year 2500 request a reversal to begin a second family. For such men, vasectomy reversal has recently been replaced in part by testicular biopsy via fine-needle testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) performed at an outpatient clinic and subsequently used in ICSI. Since these were previously fertile men it has been assumed that they had ‘fertile’ sperm. However the assited conception success rates of these mens partners has not been assessed until recently. We have shown a significant reduction in the clinical pregnancy rates in the partners of men who had had a vasectomy ≥10yrs previously. There is also evidence to suggest that spermatogenesis is significantly impaired in vasectomised men. Marked decreases in spermatocytes, spermatids and spermatozoa have been observed. We have found this to be associated with concomitant increases in apoptotic markers, such as Fas, FasL and Bax. The quality of the remaining sperm is also compromised. Sperm DNA from vasectomized men shows substantial damage which increases with time after surgery. This new use of ICSI will be discussed.
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Parekattil SJ, Kuang W, Kolettis PN, Pasqualotto FF, Teloken P, Teloken C, Nangia AK, Daitch JA, Niederberger C, Thomas AJ. Multi-Institutional Validation of Vasectomy Reversal Predictor. J Urol 2006; 175:247-9. [PMID: 16406922 DOI: 10.1016/s0022-5347(05)00027-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 04/24/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Some urologists who perform vasectomy reversals are not experienced with performing VE. A model to preoperatively identify patients who may require referral to an experienced VE surgeon was created (). We tested the model at multiple institutions. MATERIALS AND METHODS The model had previously been designed in 483 patients who underwent vasectomy reversal at 1 institution (100% sensitive and 59% specific for predicting the need for VE). It was based on time since vasectomy and patient age. We tested it prospectively in 33 patients and retrospectively in a total of 312 at 6 other institutions. The predictive accuracy of the model was compared to using a simple duration from vasectomy cutoff alone, as is used in clinical practice. RESULTS The model had 84% sensitivity and 58% specificity for detecting the need for VE in a total of 345 patients at 7 institutions. If using only a duration from vasectomy cutoff of 10 years to predict the need for VE, sensitivity was only 69%. At a cutoff of 4 years sensitivity was 99% but specificity was only 23%. Thus, the model performed better than any specific duration cutoff alone. CONCLUSIONS The predictive model provides 84% sensitivity for detecting patients who may require VE during vasectomy reversal across 7 institutions (58% specificity). The model more accurately predicts the need for VE than using a specific duration from vasectomy cutoff alone.
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McVicar CM, O'Neill DA, McClure N, Clements B, McCullough S, Lewis SEM. Effects of vasectomy on spermatogenesis and fertility outcome after testicular sperm extraction combined with ICSI. Hum Reprod 2005; 20:2795-800. [PMID: 15958397 DOI: 10.1093/humrep/dei138] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Each year 40,000 men have a vasectomy in the UK whilst another 2400 request a reversal to begin a second family. Sperm can now be obtained by testicular biopsy and subsequently used in assisted conception with ICSI. The study aims were to compare sperm yields of men post-vasectomy or with obstructive azoospermia (OA) of unknown aetiology with yields of fertile men and to assess any alteration in the clinical pregnancy rates after ICSI. METHODS Testicular tissue was obtained by Trucut needle from men who had undergone a vasectomy >5 years previously or had OA from other causes and from fertile men during vasectomy. Seminiferous tubules were milked to measure sperm yields. Numbers of Sertoli cells and spermatids and thickness of the seminiferous tubule walls were assessed using quantitative computerized analysis. RESULTS AND CONCLUSIONS Sperm yields/g testis were significantly decreased in men post-vasectomy and in men with OA, relative to fertile men. Significant reductions were also observed in early (40%) and mature (29%) spermatid numbers and an increase of 31% was seen in the seminiferous tubule wall (basal membrane and collagen thickness) of vasectomized men compared with fertile men. Clinical pregnancy rates in couples who had had a vasectomy were also significantly reduced.
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Affiliation(s)
- C M McVicar
- Obstetrics and Gynaecology, School of Medicine, Queen's University Belfast, Institute of Clinical Science, UK.
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Parekattil SJ, Kuang W, Agarwal A, Thomas AJ. Model to predict if a vasoepididymostomy will be required for vasectomy reversal. J Urol 2005; 173:1681-4. [PMID: 15821548 DOI: 10.1097/01.ju.0000154608.08496.f2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE We devised a model to predict, preoperatively, the need for a vasoepididymostomy (VE) when performing a vasectomy reversal. Urologists could use it to identify those patients who need a referral to an experienced VE surgeon. MATERIALS AND METHODS We performed a retrospective review of 483 patients who underwent vasectomy reversal by a single surgeon (AJT) including 393 vasovasostomies and 90 vasoepididymostomies. Selection was based on chart availability. Established criteria were used in deciding the type of reversal (eg gross appearance and microscopic examination of vasal fluid). Type of reversal, patient age and time since vasectomy were recorded. Univariate analysis revealed that patient age (p <0.001) and time since vasectomy (p <0.001) were significant predictors of reversal type. On multivariate logistic regression analysis, time since vasectomy (p <0.001) was the only significant independent predictor. We designed a linear regression algorithm based on time since vasectomy and patient age to predict if a VE would be performed. The model was designed using 433 patients and then tested on a separate randomly selected 50 patient group. The model was designed to be 100% sensitive in detecting patients requiring VE. RESULTS In the test group the model was 100% sensitive in predicting VE with a specificity of 58.8%. The area under the ROC curves for the design and test groups was 0.8. Palm (PalmSource Inc., Sunnyvale, California) and Windows (Microsoft Corporation, Redmond, Washington) versions are available as free shareware from www.uroengineering.com. CONCLUSIONS The model is 100% sensitivity in detecting those patients who may require a VE during vasectomy reversal (specificity of 58.8%). It may allow urologists to preoperatively identify these patients.
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Affiliation(s)
- Sijo J Parekattil
- Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Abstract
PURPOSE We examined the indications for vasovasostomy (VV) in the convoluted vas deferens as well as the outcome of this procedure. MATERIALS AND METHODS We retrospectively analyzed the indications and outcomes of all vasectomy reversals performed in the convoluted vas deferens (CVV). Indications for CVV were clear fluid with or without sperm, motile or nonmotile sperm, or sperm parts. Patency was defined as motile sperm in the ejaculate postoperatively. Pregnancy data were calculated based on natural pregnancy occurring within year 1 postoperatively. RESULTS A total of 48 patients underwent bilateral CVV (42) or unilateral CVV (6) when there was an unreconstructable/atrophic contralateral side. Average patient age was 39 years. Average age of the female partner was 30 years. The average obstructive interval was 10 years. The patency rate was 88% (38 of 43 cases). The natural pregnancy rate was 48% (15 of 31 cases). There was a significant difference in the patency rate in patients with sperm or sperm parts compared to those with clear fluid alone (p = 0.015). There was no difference in the pregnancy rate. CONCLUSIONS Vasovasostomy in the CVV is a technically more difficult procedure than standard VV. Nevertheless, postoperative results are typically comparable to those obtained via VV and superior to those of epididymovasostomy in many cases. Therefore, we recommend CVV using the same indications as for standard VV in the straight portion of the vas deferens. However, consideration for epididymovasostomy should be given when no sperm are seen in the vasal fluid intraoperatively.
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Affiliation(s)
- Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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