Vasovasostomy and Vasoepididymostomy Workup
- Author: Edmund S Sabanegh, Jr, MD; Chief Editor: Edward David Kim, MD, FACS more...
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- 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.
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- 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.
Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978 Nov. 30(5):565-71. [Medline].
O'Conor VJ. Anastomosis of vas deferens after purposeful division for sterility. J Am Med Assoc. 1948 Jan 17. 136(3):162. [Medline].
Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. Aust N Z J Surg. 1977 Jun. 47(3):305-9. [Medline].
Silber SJ. Perfect anatomical reconstruction of vas deferens with a new microscopic surgical technique. Fertil Steril. 1977 Jan. 28(1):72-7. [Medline].
Dewire DM, Thomas AJ. Microsurgical end-to-side vasoepididymostomy. Goldstein M, ed. Surgery of Male Infertility. Philadelphia, Pa: WB Saunders Co; 1995. 128-34.
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. 1991 Mar. 145(3):505-11. [Medline].
Grober ED, Karpman E, Fanipour M. Vasectomy reversal outcomes among patients with vasal obstructive intervals greater than 10 years. Urology. 2014 Feb. 83 (2):320-3. [Medline].
Scovell JM, Mata DA, Ramasamy R, Herrel LA, Hsiao W, Lipshultz LI. Association between the presence of sperm in the vasal fluid during vasectomy reversal and postoperative patency: a systematic review and meta-analysis. Urology. 2015 Apr. 85 (4):809-13. [Medline].
Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992 Jul 4. 340(8810):17-8. [Medline].
Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. 1997 Aug. 158(2):467-70. [Medline].
Berardinucci D, Zini A, Jarvi K. Outcome of microsurgical reconstruction in men with suspected epididymal obstruction. J Urol. 1998 Mar. 159(3):831-4. [Medline].
Boorjian S, Lipkin M, Goldstein M. The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. J Urol. 2004 Jan. 171(1):304-6. [Medline].
Fogdestam I, Fall M, Nilsson S. Microsurgical epididymovasostomy in the treatment of occlusive azoospermia. Fertil Steril. 1986 Nov. 46(5):925-9. [Medline].
Hernandez J, Sabanegh ES. Repeat vasectomy reversal after initial failure: overall results and predictors for success. J Urol. 1999 Apr. 161(4):1153-6. [Medline].
Kolettis PN. Restructuring reconstructive techniques--advances in reconstructive techniques. Urol Clin North Am. 2008 May. 35(2):229-34, viii-ix. [Medline].
Marmar JL. Management of the epididymal tubule during an end-to-side vasoepididymostomy. J Urol. 1995 Jul. 154(1):93-6. [Medline].
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.
Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. 2005 Nov. 174(5):1926-31; discussion 1931. [Medline].
Parekattil SJ, Kuang W, Agarwal A, Thomas AJ. Model to predict if a vasoepididymostomy will be required for vasectomy reversal. J Urol. 2005 May. 173(5):1681-4. [Medline].
Patel SR, Sigman M. Comparison of outcomes of vasovasostomy performed in the convoluted and straight vas deferens. J Urol. 2008 Jan. 179(1):256-9. [Medline].
Pierpaoli S, Mulhall JP. Vasectomy reversal in the age of intracytoplasmic sperm injection. Curr Opin Urol. 1998 Nov. 8(6):531-4. [Medline].
Shin D, Chuang WW, Lipshultz LI. Vasovasostomy. BJU Int. 2004 Jun. 93(9):1363-78. [Medline].
Sigman M. The relationship between intravasal sperm quality and patency rates after vasovasostomy. J Urol. 2004 Jan. 171(1):307-9. [Medline].
Silber SJ. Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal. Fertil Steril. 1979 Mar. 31(3):309-15. [Medline].
Thomas AJ. Vasoepididymostomy. Thomas AJ, Nagler HM, eds. Atlas of Surgical Management of Male Infertility. New York: Igaku-Shoin; 1995. 62-70.
Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am. 1987 Aug. 14(3):527-38. [Medline].
Vasectomy reversal. Fertil Steril. 2006 Nov. 86(5 Suppl):S268-71. [Medline].