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Asian Journal of Andrology (2013) 15, 44β48; doi:10.1038/aja.2012.79; published online 12 November 2012
Microsurgical vasovasostomy
Lindsey Herrel and Wayland Hsiao
Emory University, Department of Urology, Atlanta, GA 30322, USA
Correspondence: Dr W Hsiao, (whsiao@emory.edu)
Received 9 July 2012; Revised 14 August 2012; Accepted 20 August 2012
Advance online publication 12 November 2012
| Abstract |
Up to 6% of men who have undergone vasectomy will ultimately elect for reversal in the form of vasovasostomy or vasoepididymostomy for various reasons. Vasovasostomy performed to regain fertility is a technique that has undergone numerous advances during the last century, including the use of microsurgical equipment and principles to construct a meticulous anastomosis. It is important during vasovasostomy to ensure good blood supply to the anastomosis as well as to build as a tension-free anastomosis. Visual inspection to ensure healthy mucosa and inner muscularis as well as atraumatic handling of tissues is helpful. With vasovasostomy, it is essential to create a watertight anastomosis to prevent secondary scar formation. The microdot technique of vasovasostomy allows for markedly discrepant lumens to be brought together more precisely. Thereby, the planning is separated from suture placement, which prevents dog-ears and avoids subsequent leaks. In the age of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), it becomes even more important to clarify outcomes after vasectomy reversals, as patients now have a choice between surgical sperm retrieval coupled with IVF/ICSI versus vasectomy reversal. Little data on long-term outcomes for vasectomy reversals exist. Therefore, further research in this field needs to evaluate the rate of late failures and the predictors of late failures.
Keywords: male infertility; microsurgery; vasectomy; vasectomy reversal; vasovasostomy |
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