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Vasovasostomy and Vasoepididymostomy Workup

  • Author: Edmund S Sabanegh, Jr, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Nov 15, 2015
 

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Vasectomy reversal

See the list below:

  • Men who request a vasovasostomy or vasoepididymostomy reversal require no further workup as long as their scrotal examination reveals normal-sized testicles and they have not developed any fertility-impacting medical conditions (eg, history of chemotherapy, radiation therapy) since their original vasectomy.
  • In the case of small testes or history of a potentially gonadotoxic insult to the testis, perform a testis biopsy at the time of, or prior to, the procedure to document normal sperm production.
  • Approximately 60% of men who undergo bilateral vasectomy develop circulating antisperm antibodies afterward, and the effect of these on conception and pregnancy is controversial. While preoperative antisperm antibody testing is available, its effects on postoperative fertility is of unproven benefit.

Nonvasectomy reversal

See the list below:

  • To be a candidate for a vasoepididymostomy, men with normal–semen volume azoospermia must have active sperm production, an epididymal obstruction, and a patent vas deferens. Normal serum gonadotropin levels (eg, follicle-stimulating hormone [FSH]) suggest normal spermatogenesis, although, occasionally, a patient with an interruption in the normal sperm development (maturation arrest) has normal FSH levels.
  • Definitive proof of normal sperm production is required and can be provided by a testis biopsy at the same time as the planned reconstruction (or at an earlier date).
  • At the time of planned reconstruction, a vasogram is performed to confirm patency of the entire vas deferens and ejaculatory duct. Performing a vasogram at an earlier time may result in scarring of the vas, rendering definitive reconstruction more difficult.
 
 
Contributor Information and Disclosures
Author

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

Coauthor(s)

Mary K Samplaski, MD Resident Physician, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation

Mary K Samplaski, MD is a member of the following medical societies: American Medical Association, American Urological Association

Disclosure: Nothing to disclose.

Yagil Barazani, MD Clinical Fellow in Male Infertility and Microsurgery, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Medscape Reference thanks Dennis G Lusaya, MD, Associate Professor II, Department of Surgery (Urology), University of Santo Tomas; Head of Urology Unit, Benavides Cancer Institute, University of Santo Tomas Hospital; Chief of Urologic Oncology, St Luke’s Medical Center Global City, Philippines, for the video contribution to this article.

Medscape Reference also thanks Edgar V Lerma, MD, FACP, FASN, FAHA, Clinical Associate Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training Program, Advocate Christ Medical Center; Consulting Staff, Associates in Nephrology, SC, for his assistance with the video contribution to this article.

References
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Sperm is produced in the seminiferous tubules and then transits through the rete testis, through the efferent duct, and into the epididymal tubule. Image reprinted with permission from Cleveland Clinic.
Vasovasostomy modified one-layer technique: (A) A 9-0 nylon suture is passed through the entire vas wall, traveling full thickness through both ends. (B) Two 8-0 nylon seromuscular sutures are placed on either side of the 9-0 suture. (C) This pattern is repeated in each quadrant of the anastomosis, resulting in a total of 4 luminal sutures and 8 seromuscular sutures.
Vasovasostomy formal two-layer technique: (A) 9-0 nylon seromuscular sutures are placed in the posterior end of the vas at the 5- and 7-o'clock positions. (B) Six interrupted 10-0 nylon mucosal sutures are then placed to approximate the luminal ends of the deferens. (C) Finally, 4 additional 9-0 nylon seromuscular sutures complete the second layer of the anastomosis.
Vasoepididymostomy end-to-side technique: (A) Two 9-0 nylon sutures are used to secure the seromuscular layer of the vas to the epididymal tunic. (B) Four 10-0 nylon sutures are then placed to secure the mucosa of the vas to the epididymal tubule. (C) Finally, six to eight 9-0 nylon sutures are used to secure the seromuscular layer of the vas to the epididymal tunic.
Table 1. Surgically Correctable Causes of Ductal Obstruction
Table 2. Microsurgical Vasovasostomy
Table 3. Microsurgical Vasoepididymostomy
J stent insertion for the treatment of malignant obstruction. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Vasectomy reversal. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
 
 
 
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