Vasovasostomy and Vasoepididymostomy Workup

  • Author: Edmund S Sabanegh Jr, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Nov 12, 2011
 

Other Tests

Vasectomy reversal

  • 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

  • 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.
Proceed to Treatment & Management
 
 
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 for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group

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 and American Urological Association

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: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

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, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

Additional Contributors

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

  1. Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. Nov 1978;30(5):565-71. [Medline].

  2. O'Conor VJ. Anastomosis of vas deferens after purposeful division for sterility. J Am Med Assoc. Jan 17 1948;136(3):162. [Medline].

  3. Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. Aust N Z J Surg. Jun 1977;47(3):305-9. [Medline].

  4. Silber SJ. Perfect anatomical reconstruction of vas deferens with a new microscopic surgical technique. Fertil Steril. Jan 1977;28(1):72-7. [Medline].

  5. Dewire DM, Thomas AJ. Microsurgical end-to-side vasoepididymostomy. In: Goldstein M, ed. Surgery of Male Infertility. Philadelphia, Pa: WB Saunders Co; 1995:128-34.

  6. Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. Mar 1991;145(3):505-11. [Medline].

  7. Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. Jul 4 1992;340(8810):17-8. [Medline].

  8. Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. Aug 1997;158(2):467-70. [Medline].

  9. Berardinucci D, Zini A, Jarvi K. Outcome of microsurgical reconstruction in men with suspected epididymal obstruction. J Urol. Mar 1998;159(3):831-4. [Medline].

  10. Boorjian S, Lipkin M, Goldstein M. The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. J Urol. Jan 2004;171(1):304-6. [Medline].

  11. Fogdestam I, Fall M, Nilsson S. Microsurgical epididymovasostomy in the treatment of occlusive azoospermia. Fertil Steril. Nov 1986;46(5):925-9. [Medline].

  12. Hernandez J, Sabanegh ES. Repeat vasectomy reversal after initial failure: overall results and predictors for success. J Urol. Apr 1999;161(4):1153-6. [Medline].

  13. Kolettis PN. Restructuring reconstructive techniques--advances in reconstructive techniques. Urol Clin North Am. May 2008;35(2):229-34, viii-ix. [Medline].

  14. Marmar JL. Management of the epididymal tubule during an end-to-side vasoepididymostomy. J Urol. Jul 1995;154(1):93-6. [Medline].

  15. Martin E, Carnett JB, Levi JV. The surgical treatment of sterility due to obstruction at the epididymis. Together with a study of the morphology of human spermatozoa. Medical Bulletin: University of Pennsylvania. 1903;15:2.

  16. Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. Nov 2005;174(5):1926-31; discussion 1931. [Medline].

  17. Parekattil SJ, Kuang W, Agarwal A, Thomas AJ. Model to predict if a vasoepididymostomy will be required for vasectomy reversal. J Urol. May 2005;173(5):1681-4. [Medline].

  18. Patel SR, Sigman M. Comparison of outcomes of vasovasostomy performed in the convoluted and straight vas deferens. J Urol. Jan 2008;179(1):256-9. [Medline].

  19. Pierpaoli S, Mulhall JP. Vasectomy reversal in the age of intracytoplasmic sperm injection. Curr Opin Urol. Nov 1998;8(6):531-4. [Medline].

  20. Shin D, Chuang WW, Lipshultz LI. Vasovasostomy. BJU Int. Jun 2004;93(9):1363-78. [Medline].

  21. Sigman M. The relationship between intravasal sperm quality and patency rates after vasovasostomy. J Urol. Jan 2004;171(1):307-9. [Medline].

  22. Silber SJ. Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal. Fertil Steril. Mar 1979;31(3):309-15. [Medline].

  23. Thomas AJ. Vasoepididymostomy. In: Thomas AJ, Nagler HM, eds. Atlas of Surgical Management of Male Infertility. New York: Igaku-Shoin; 1995:62-70.

  24. Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am. Aug 1987;14(3):527-38. [Medline].

  25. Vasectomy reversal. Fertil Steril. Nov 2006;86(5 Suppl):S268-71. [Medline].

 
Previous
Next
 
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 multilayer 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 single-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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.